Service information form
WHO IS RETURNING THE EQUIPMENT? | Date: | |
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Person to contact: __________________________________________ | Phone: ________________ | |
Alternate contact: __________________________________________ | Phone: ________________ | |
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Return shipping address: | Special shipping instructions: |
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WHAT ARE YOU SENDING? |
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Model name: | Model number: | Serial number: |
Please attach any relevant printouts. Do NOT ship accessories (manuals, cleaning supplies, etc.) that are not required to complete the repair.
HAVE YOU REMOVED THE PRINT CARTRIDGES AND IMAGING DRUM?
You must remove them before shipping the printer, unless a mechanical problem prevents you from doing so.
Yes. No, I cannot remove them.
WHAT NEEDS TO BE DONE? (Attach a separate sheet if necessary.)
1. Describe the conditions of the failure. (What was the failure? What were you doing when the failure occurred? What software were you running? Is the failure repeatable?)
2. If the failure is intermittent, how much time elapses between failures? _______________________________
3. If the unit connected to any of the following, give the manufacturer and model number.
Personal computer: | Modem: | Network: |
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4. Additional comments: |
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HOW WILL YOU PAY FOR THE REPAIR?
Under warranty | Purchase/received date: ____________________________ |
(Attach proof of purchase or receiving document with original received date.)
Maintenance contract number: ______________________
Purchase order number: ___________________________
Except for contract and warranty service, a purchase order number and/or authorized signature must accompany any
request for service. If standard repair prices do not apply, a minimum purchase order is required. Standard repair prices can be obtained by contacting an
Authorized signature: ____________________________________________ | Phone: _________________________ | |
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Billing address: | Special billing instructions: |
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EN | Appendix A Service and support 111 |