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e 28~~~~~Q!ons Equipment Removal Form Customer: Kittitas County Corrections Department Address: 507 N Pine St, #D 601 Dexter Ave N Seattle, WA 98109 P: (206) 282-1200 F: (206) 282-2010 www.coplersnw.com Ellensburg, WA 98926 Phone: (509) 962-7700 A R R' h K ccount ep: IC ay,,,, This document must be completed prior to authorizing and scheduling any equipment pickups. Please list the equipment and complete the "Trade In Section" -OR- the "Lease Return Section". Additional equipment can be listed on page two of this form. Make Model Serial Lease Return or Trade In 1 Sharp MX-M463N 25006237 Lease Retu rn 2 Trade In Sedion *00 NOT COMPLfTJ: LEASE Sec:nON FOR TRADE If£EQUIPME~ I~ [lY'lnIUallng Ul tl bOx to the left. I the Undruslg ncd agree (hal all f;!qulpme,ll marked 'ITrade rn " ~TI" or "Customw Owned" IS free arid clea r of any liens or encumbrances. The title and ownership of this equipment is transferred to Copiers NW, Ine. Copiers NW is under no C:lrOJmstiln cc responsible for any data , documents, Images, or other information stored on or In the device, the device hard drivers), or ./"" Initials ............... (tny memory module (s). **OR** Lease R~", SectiOn --LEASES O_rtLYLOO NOT flLL QUJ"fOR TRADE JHS* IPlease fill out it ~ftft~~~ •• I CODV of this f.orm for @:ach different lease. If you are trading in customer owned equipment, you do not need to comple te this section. Additional equipment on the same lease can be listed on page two of this form . D Copiers NW Leased Equipment -Copiers Northwest will manage my eqUipment return as part of the lease upgrade and/or buyout as the orlgloaUng dealer of the returned equipment. 0 Non-Copiers NW Leased Equipment -Customer must fill out the following sections as a requirement of CNW picking up the eqUipment and returning it to the leasing company . A Lease Copy -Please submit a copy of the lease for the equipment listed above and/or on page two of this form. It contains important terms and conditions that may dictate ownership and return information. B Letter of Intent - A letter of intent is usually sent 30 to 120 days prior to lease end, and It is rll 's II~V to notifl, L§1!l!i09 ~2DlI1~Dll Q[ th§I[ IDte !l1i21l 10 [etyCD lbg §gu!l!m!jnt· It is important that you check the terms and conditions of your lease for specific reqUirements. Customer Contact 1 Ema il :l l1eather.seibert.sh@co.klltltas.wa.us Customer Contact 2 Email : I C Shipping Instructions -Return shipping instructions must be forwarded immediately upon receipt to CNW via certified mail to the address above ATTN: LEASING or via email to equipmentreturns@copiersnw.com. Expected Return Date : I I 0 Buyout Check -The Buyout Check to you, Customer, is intended to offset the remaining stream of payments due under the existing lease contract. Customer is solely responsible for this lease contract(s) and Copiers Northwest accepts no responsibility for any additional charges unless specifically noted. Maximum Buyout Amount: I !4,O42.801 ONO buyout check Check Options: o Buyout to be paid by Copiers Northwest to Customer who will pay Leasing Company . ~ Buyout to be paid by Copiers Northwest to Leasing Company. A copy of the buyout invoice from the Leasing Co must be provided to CNW to select this option. Notes : Coprels NW agrees to remit any Ouyoul check Induded in the new lease Vl lt~ln 30 bUSiness Qays of the fu ndin g of th e new lea!iEl unlC1is Customer hlls raIled to provide suffiCient documenUitton including: lease copy, letter of intent, shipping instrUctions and/or signed lease buyo ut letter. Copiers NW agrees to store said equipment at Customer's request rot a period not to exceed 90 days from removal from Customer's location. After 90 days, Copiers NW reserves the right to charge storage fees until the equipment is shipped u~CIi; to Leasing Company, Copiers NW is not responsible far damaged or stolen equipment. Customer must maintain insurance coverage on equipment until said eqUipment is rece.lved by Leasing Company or Leasing Company's agent. Copiers NW is under no circumstance responsible for any data, documents, images, or any other information stored (In or in the device, the device hard drivers), or any memory module(s). ACCEPTED BY COPIERS NORTHWEST Printed Na me / Title Authorized Signatu re Required I Date Revision 1505a ()bit 0' bJr/€fl ') f)fJtL /!!JLlU;~ RECEIVED prlntec.Nam R EC EIVED KITTITAS COUNTY SHERIFF ACCOUNTING KITTITAS COUUTV SHERIFF ACCOUtHlMG