John P. O'Sullivan Distributing

DAMAGED EQUIPMENT FORM

First Name:

Last Name:

Department:

Date of Incident

Equipment Type:

Is this equipment enabled with cellular data?

Yes

No

I am not sure

Details of how the damaged occurred

Supervisor Name:

Your form has been submitted. Please leave the damaged equipment at the front desk with your name attached.

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Contact Us

John P. O'Sullivan Distributing, Inc.

9300 Enterprise Way

Holly, MI 48442

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