Quarterly Meter Reading Entry Form

Please provide the following contact information:

Name
Organization
Work Phone
E-mail

	Copier Serial Number	Usually on "counter check" screen or back cover
	Copier Model	Usually on front cover
If you need assistance finding the counters, please give us a call at 336-788-2100 x 102
	Counter #101	Please enter all digits
	Counter # 102	Please enter all digits
	Counter # 102	Please enter all digits
	Counter # 109	Please enter all digits
	Counter # 124	Please enter all digits

Please enter any comments below:

Please enter verification code and submit form:

Comment: Please remember to submit a separate form for each copier.   Thank you for your prompt attention.