ATR Inbound Form

Date of Arrival at ATR:

Optio S/N:

Origin Organization:

Origin Address:

Street 1:

Street 2:

City:

State:
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Zip:

RMA #:

Verify the following:

IMPORTANT: IF ANY OF THE ABOVE BOXES ARE NOT CHECKED YOU SHOULD SUBMIT THIS FORM AND CONTACT LOBBYGUARD BEFORE PROCEEDING WITH ANY FURTHER STEPS WITH THIS KIOSK.