Epson Stylus Pro 10000 Series Warranty page 27

2 Year Extended Service Plan for EPSON Stylus Pro 10000 Printer
Product Code EPP10B2 Certificate No:
Mr. 01 First Name
Ms. 02 _ _ _ _ _ _ _ _ _ _ _ _ _
Title
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Company
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Mailing Address
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
City
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
State / Province Country
_ _
U.S. 01
Is this mailing address a
Residence 01 Business
Email Address
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Product Serial Number
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
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.
Via Email
(Note: Your information is not rented, sold, or shared with other companies in accordance
(XXXX)
Middle Initial
Zip Code (U.S. only)
_ _ _ _ _
Canada 02
Area Code / Phone Number
_ _ _ _ _ _ - _ _ _ _
02 /
7 Digit Unit I.D. No:
Please let us know how you would like to be contacted:
Via Mail
with our Privacy Policy, which is online at www.epson.com.)
Last Name
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Postal Code (Canada only)
_ _ _ _ _ _
_ _ _ _
Ext. Day
Printer Purchase Date
__________________________________________
(Must be within 90 days of Service Plan enrollment)
I prefer that Epson not contact me.
01 Eve 02