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 relocations@aus.fujixerox.com

Quote Ref EOE Ref Incident Ref

MACD Form Version 1.0 Fuji Xerox Australia Limited