Epson Stylus Pro 10000 - Photographic Dye Ink Warranty Statement - Page 17

Year Extended Service Plan for EPSON Stylus Pro 10000 Printer

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1 Year Extended Service Plan for EPSON Stylus Pro 10000 Printer Product Code EPP10B1 Certificate No: (XXXX) Mr. 01 First Name Middle Initial Ms. 02 Last Name Title Company Mailing Address City State / Province Country Zip Code (U.S. only) _ _ U.S. 01 Canada 02 _ _ _ _ _ Postal Code (Canada only) _ _ _ _ _ _ Is this mailing address a Residence 01 Business 02 Area Code / Phone Number Ext. _ _ _ _ Day 01 Eve 02 Email Address Product Serial Number 7 Digit Unit I.D. No: Printer Purchase Date (Must be within 90 days of Service Plan enrollment) Customer Signature Date I have read and agree with the terms and conditions for the Preferred Plus Service Plan. If dealer is completing this form, please indicate the following: Dealer Service Account Number Dealer Phone Number Periodically, Epson would like to inform you of new product updates and special promotions. Please let us know how you would like to be contacted: Via Email Via Mail I prefer that Epson not contact me. (Note: Your information is not rented, sold, or shared with other companies in accordance with our Privacy Policy, which is online at www.epson.com.)

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Is this mailing address a
Residence
01
Business
02
1 Year Extended Service Plan for EPSON Stylus Pro 10000 Printer
Mr.
01
Ms.
02
First Name
Middle Initial
Last Name
_ _ _ _ _ _ _ _ _ _ _ _
_
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Title
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Company
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Mailing Address
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
City
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
State / Province
Country
Zip Code (U.S. only)
Postal Code (Canada only)
_ _
U.S.
01
Canada
02
_ _ _ _ _
_ _ _ _ _ _
Email Address
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Product Serial Number
7 Digit Unit I.D. No:
Printer Purchase Date
_ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _
__________________________________________
Periodically, Epson would like to inform you of new product updates and special promotions.
Please let us know how you would like to be contacted:
Product Code
EPP10B1
Certificate No:
(XXXX)
Via Email
Via Mail
I prefer that Epson not contact me.
(Note: Your information is not rented, sold, or shared with other companies in accordance
with our Privacy Policy, which is online at www
.epson.com
.)
Area Code / Phone Number
_ _ _
/
_ _ _ - _ _ _ _
Ext.
_ _ _ _
Day
01
Eve
02
Customer Signature ________________________________________________________________
Date ____________________________
If dealer is completing this form, please indicate the following:
Dealer Service Account Number ____________________________ Dealer Phone Number __________________________
I have read and agree with the terms and conditions for the Preferred Plus Service Plan.
(Must be within 90 days of Service Plan enrollment)