HomeMy WebLinkAboutCopiers Northwest - Customer Owned Equipment Removal COPIERS Customer Owned Equipment Removal Form
e NORTHWEST
New Ideas. New Solutions Customer: City of Yakima
Address: 2406 W Washington Ave
615 S Alaska St, Seattle, WA 98108 City, State,Zip: Yakima, WA 98902
P: (206)282-1200 F: (206)282-2010
www.copiersnw.com Phone: (509) 575-6070
Account Rep: Travis McNeill
This document must be completed prior to authorizing and scheduling any CUSTOMER OWNED "Trade-Ins"which includes any equipment
customer purchased from CNW or another Vendor. Leased Equipment originating from Copiers Northwest(CNW)does not require any forms.
Customer Owned Equipment Only (CNW or other).
Please use the "NON-CNW Leased Equipment Removal Form" to authorize removal of NON-CNW leases.
Status ID # Make Model Serial
1 Customer Owned HF296 Canon C5540i XU02983
2 Customer Owned
3 Customer Owned Hard Drive to be wiped
4 Customer Owned with certificate
5 Customer Owned
6 Customer Owned
7 Customer Owned
8 Customer Owned
9 Customer Owned
10 Customer Owned
11 Customer Owned
12 Customer Owned
13 Customer Owned
14 Customer Owned
15 Customer Owned
16 Customer Owned
17 Customer Owned
18 Customer Owned
19 Customer Owned
20 Customer Owned
21 Customer Owned
22 Customer Owned
23 Customer Owned
24 Customer Owned
25 Customer Owned
26 Customer Owned
27 Customer Owned
28 Customer Owned
29 Customer Owned
30 Customer Owned
31 Customer Owned
32 Customer Owned
33 Customer Owned
34 Customer Owned
Please use a similar format to list additional CUSTOMER OWNED EQUIPMENT on supplementary pages.
THIS SECTION FOR CUSTOMER OWNED EQUIPMENT ONLY:
I the undersigned agree that all equipment marked and/or referred to as"Customer Owned"'Trade In"or"Disposal"is free and dear of any liens or
encumbrances.The title and ownership of this equipment is transferred to Copiers NW, Inc.Copiers NW is under no circumstance responsible for any data,
documents,images,or other information stored on or in the device,the device hard drive(s),or any memory module(s).
ACCEPTED BY COPIERS NORTHWEST ACCEPTED BY CUSTOMER
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Authorized Signature Required/Date Authorized Signature Required/Date
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