Indicates a required field.
Equipment ID
Sample Equipment ID Tag
Company Name
Your Name
P.O. Number
Machine Status
:: please choose ::
Operational
Not Operational
Problem
:: please choose ::
Noise
Copy Quality Dark
Copy Quality Blank
Copy Quality Light
Copy Quality Streaks
Not Printing
Feeder Jamming
Copier Jamming
Network Connectivity
Other
**Comment required for seleted problem.
Comments
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you if further information is required
Contact Phone
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Email Address