Request Equipment Move - Digital Image Solutions - Request Equipment Move

EQUIPMENT MOVE
REQUEST

Request Equipment Move

Please fill out the form below. If your prefer, contact us right now.

EQUIPMENT MOVE CONTACT INFORMATION:

Company Name: *

Contact Name: *

Phone: *

Email: *

Move FROM - CURRENT LOCATION:

Company Name: *

Requested Pick-up: *

Company Address: *

City: *

State / Region: *

Zip / Postal Code: *

Is There a Loading Dock? *

Is There an Elevator? *

Are There Stairs? *

Please describe the details about the location of current equipment:

Move TO - FUTURE LOCATION:

Company Name:

Requested Delivery Date: *

Company Address: *

City: *

State / Region: *

Zip / Postal Code: *

Is There a Loading Dock? *

Is There an Elevator? (copy) *

Are There Stairs? (copy) *

Please describe the details about the future location:

Equipment Information:

Manufacturer & Model: *

Machine ID or Serial #:

Machine Type or Description:

Working / Not Working?

Equipment 2

Check to ADD Additional Equipment (up to 10 machines - if needed)

Please include any additional useful information:

Required Security Question: *

Required Security Question: What is 100+25?

Email