Panasonic UF-490 Service Manual page 159

Ship to:
Attention:
Phone No.:
Customer ID: ABC COMPANY (5)
Drum Unit: UG-3220
Print your name and title
Explanation of Contents
(1) Replace Drum Message
(2) Dealer Name
(3) Order Tel #
(4) Order Fax #
(5) Customer ID
(6) Drum Unit #
*****************************
> DRUM UNIT ORDER FORM
*****************************
**** It is time to replace the Drum Unit ****
To order a replacement Drum Unit from your Authorized Dealer
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
=========================
(6)
Quantity Required:
<
Bill to:
Attention:
Phone No.:
P.O. No.(if required):
Serial No.:
Signature & Date
"It is time to replace the Drum Unit"
Up to 25 digits
Up to 36 digits
Up to 36 digits
Up to 16 characters (User Identification Code)
UG-3220
159
(1)
/ /