Panasonic UF-5500 Service Manual page 109

(Sample)
To order a replacement Cartridge from your Authorized Dealer
Ship to:
Attention:
Phone No.:
Customer ID: ABC COMPANY (5)
Toner Cartridge: XX-XXXX
Print your name and title
Explanation of Contents
(1) Replace Drum Message (Fixed)
(2) Dealer Name
(3) Order Tel #
(4) Order Fax #
(5) Customer ID
(6) Drum Cartridge #
*************************************
> DRUM CARTRIDGE ORDER FORM
*************************************
**** It is time to replace the drum cartridge **** (1)
Panasonic Corp. (2)
by Phone: 1 201 111 5555 (3)
by Fax: 1 201 111 4444 (4)
Thank you for your order.
Customer Name and Address
=========================
Bill to:
Attention:
Phone No.:
P.O. No.(if required):
(6) Serial No.:
Quantity Required:
Signature & Date
"It is time to replace the Drum Cartridge"
Up to 25 digits
Up to 36 digits
Up to 36 digits
Up to 16 characters (User Identification Code)
UG-5590 (For USA / Canada) for UF-5500/UF-4500
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UF-5500 / 4500
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