Relocation Request (Customer/Equipment Info)



"Requests entered in this form and submitted via this link are for transport of Canon U.S.A., Inc. (CUSA) owned or Canon leased equipment only. Requests to move customer owned equipment requires written release of liability to Canon as well as written approval from Procurement/Logistics VP or Director."
 
The fields in 'Red' or 'Highlighted' are required.
Requestor Name * Requestor Email Address *
    Alternate Email Address 1
    Alternate Email Address 2
    Alternate Email Address 3
Move Equipment (From) Move Equipment (To)
Company Name * Company Name *
Address * Address *
Floor/Suite Floor/Suite
City * City *
State * State *
Zip Code * Zip Code *
Primary Contact Info: *
Contact Name * Contact Name *
Contact Phone # * Contact Phone # *
Contact Cell # * Contact Cell # *
Alternate Contact Info:
Contact Name Contact Name
Contact Phone # Contact Phone #
Contact Cell # Contact Cell #
Is Company Keeping the current location? * Yes No
Canon U.S.A., Inc. (CUSA) requires this information In order to facilitate changes of address or the Company name and to ensure Invoices, Statements & deliveries all make it to correct destination.
Are you an American Reprographics Company Customer? * Yes No
Model*    
Engine Serial # * Scanner Serial #
Requested Pickup Date Requested Delivery Date
Special Requirements: