Epson Stylus Pro 10000 Series - 1 Year Plan Enrollment Form

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Residence 01 Business 02
1 Year Extended Service Plan for EPSON Stylus Pro 10000 Printer
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City
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State / Province Country Zip Code (U.S. only) Postal Code (Canada only)
_ _ U.S. 01 Canada 02 _ _ _ _ _ _ _ _ _ _ _
Email Address
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Product Serial Number 7 Digit Unit I.D. No: Printer Purchase Date
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__________________________________________
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
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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)