Fuji Xerox Device Relocation Authority FormInvoice Information
Account Name Edith Cowan University Account Number L10989
Invoice Address Attention of
Quoted Price $180.00 PO Number
Requested Date Click here to enter a date. ☒ AM ☐ PM
Signature:
Analyst Required ☐ Yes ☐ No PaperCut (Monitor)
Device Information
Model Serial Number
Current Location
Site (Optional)
Address
Building Level Room
Primary Contact Contact Number
Secondary Contact Contact Number
Site Specifics(Please select where applicable)
Site Hours 8am - 5pm Site Inductions ☒ Yes ☐ No
Parking ☒ Onsite ☐ Street ☐ Loading Zone ☐ Loading Dock (Height m)
Stairs ☐ Yes ☒ No If yes, how many stairs/flights of stairs (estimate)?
Lift Access ☒ Yes ☐ No Approx. Dimensions m x m
PPE Required no
Any additional information (if required);
Proposed Location
Site (Optional)
Address
Building Level Room
Primary Contact Contact Number
Secondary Contact Contact Number
Site Specifics(Please select where applicable)
Site Hours Site Inductions ☐ Yes ☐ No
Parking ☒ Onsite ☐ Street ☐ Loading Zone ☐ Loading Dock (Height m)
Stairs ☐ Yes ☒ No If yes, how many stairs/flights of stairs (estimate)?
Lift Access ☒ Yes ☐ No Approx. Dimensions m x m
PPE Required
Any additional information (if required):
Email to [email protected]
Quote Ref EOE Ref Incident Ref
MACD Form Version 1.0 Fuji Xerox Australia Limited
