Canon imageRUNNER ADVANCE C5560 Configuration And Installation Manual page 63

CERTIFICATION OF HARD DISK DRIVE ERASURE OR REMOVAL
In accordance with Master Equipment Purchase and Maintenance Agreement dated
May 15, 2015, Section 16, Security Requirements, and inclusive of all Statements of
Work and corresponding Amendments, by and among the Parties, Canon USA and Canon
Dealer Servicers hereby certify that all hard drives have either been erased or removed
from the existing Machine and / or controllers. In the case of hard drive removal, the hard
drive will be provided to the FedEx Office Center Manager as noted below, for disposal
by FedEx Office in accordance with FedEx Office approved disposal procedures.
Center Number: ____________________
Date: _____________________________
Serial Number: _____________________
Center Manager Name: ___________________________________
Center Manager Signature: ___________________________________
Technician Name: ___________________________________
Technician Signature: ___________________________________
Upon completion of this form, please scan and email to:
FXO_Order_Management@cusa.canon.com