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Service Request
Michelle Bates
2024-04-17T00:34:31-04:00
SERVICE REQUEST
Please complete the service request form below.
"
*
" indicates required fields
Company Name
*
Name
*
First
Address
*
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
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Colorado
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Delaware
District of Columbia
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Vermont
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West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Zip Code (Required)
Phone
*
Email
*
Location (Room Number / Department)
How many devices need service?
*
1
2
3
4
5
DEVICE 1:
Please provide the equipment ID or serial number.
*
Please select one or the other. To better serve you, this is required.
Equipment ID
Serial Number
Equipment ID (Device 1)
*
Serial Number (Device 1)
*
What challenge are you having with the device? (error codes, jamming, image quality, etc)
*
Are you experiencing challenges printing to or scanning from a PC?
No
Yes
Hrs. of Operation or Additional Comments
DEVICE 2:
Please provide the equipment ID or serial number.
*
Please select one or the other. To better serve you, this is required.
Equipment ID
Serial Number
Equipment ID (Device 2)
*
Serial Number (Device 2)
*
What challenge are you having with the device? (error codes, jamming, image quality, etc)
*
Are you experiencing challenges printing to or scanning from a PC?
No
Yes
Hrs. of Operation or Additional Comments
DEVICE 3:
Please provide the equipment ID or serial number.
*
Please select one or the other. To better serve you, this is required.
Equipment ID
Serial Number
Equipment ID (Device 3)
*
Serial Number (Device 3)
*
What challenge are you having with the device? (error codes, jamming, image quality, etc)
*
Are you experiencing challenges printing to or scanning from a PC?
No
Yes
Hrs. of Operation or Additional Comments
DEVICE 4:
Please provide the equipment ID or serial number.
*
Please select one or the other. To better serve you, this is required.
Equipment ID
Serial Number
Equipment ID (Device 4)
*
Serial Number (Device 4)
*
What challenge are you having with the device? (error codes, jamming, image quality, etc)
*
Are you experiencing challenges printing to or scanning from a PC?
No
Yes
Hrs. of Operation or Additional Comments
DEVICE 5:
Please provide the equipment ID or serial number.
*
Please select one or the other. To better serve you, this is required.
Equipment ID
Serial Number
Equipment ID (Device 5)
*
Serial Number (Device 5)
*
What challenge are you having with the device? (error codes, jamming, image quality, etc)
*
Are you experiencing challenges printing to or scanning from a PC?
No
Yes
Hrs. of Operation or Additional Comments
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Email
This field is for validation purposes and should be left unchanged.
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