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Move Out Date: _________________ Return Date: ___________________ (Students returning to property)

AM3 00001

Receiver Serial Number: DVR Y/N (circle Y or N) Customer Name: ___________________________ Customer ID: ______________________________ Email: ___________________________________ Phone Number: ____________________________ Property Name: ____________________________ Apt #: _________ AM3 Initial: _______

Receiver #: _________________________________________

1 Smart Card #: _______________________________________ Receiver #: _________________________________________ 2 Smart Card #: _______________________________________ Receiver #: _________________________________________ 3 Smart Card #: _______________________________________ Receiver #: _________________________________________ 4 Smart Card #: _______________________________________ Receiver #: _________________________________________

5 Smart Card #: _______________________________________

Customer Signature: ____________________________________

Remote Control QTY: _______

DVR Y/N DVR Y/N DVR Y/N DVR Y/N DVR Y/N

AM3 COPY


Move Out Date: _________________ Return Date: ___________________ (Students returning to property)

AM3 00001

Receiver Serial Number: DVR Y/N (circle Y or N) Customer Name: ___________________________ Customer ID: ______________________________ Email: ___________________________________ Phone Number: ____________________________ Property Name: ____________________________ Apt #: _________ AM3 Initial: _______

Receiver #: _________________________________________

1 Smart Card #: _______________________________________ Receiver #: _________________________________________ 2 Smart Card #: _______________________________________ Receiver #: _________________________________________ 3 Smart Card #: _______________________________________ Receiver #: _________________________________________ 4 Smart Card #: _______________________________________ Receiver #: _________________________________________

5 Smart Card #: _______________________________________

Customer Signature: ____________________________________

Remote Control QTY: _______

DVR Y/N DVR Y/N DVR Y/N DVR Y/N DVR Y/N

STUDENT COPY


Move Out Date: _________________ Return Date: ___________________ (Students returning to property)

AM3 00001

Receiver Serial Number: DVR Y/N (circle Y or N) Customer Name: ___________________________ Customer ID: ______________________________ Email: ___________________________________ Phone Number: ____________________________ Property Name: ____________________________ Apt #: _________ AM3 Initial: _______

Receiver #: _________________________________________

1 Smart Card #: _______________________________________ Receiver #: _________________________________________ 2 Smart Card #: _______________________________________ Receiver #: _________________________________________ 3 Smart Card #: _______________________________________ Receiver #: _________________________________________ 4 Smart Card #: _______________________________________ Receiver #: _________________________________________

5 Smart Card #: _______________________________________

Customer Signature: ____________________________________

Remote Control QTY: _______

DVR Y/N DVR Y/N DVR Y/N DVR Y/N DVR Y/N

TECH/PRC COPY


AM3 Carbon Moving Checklist Pad