Printer Ink Cartridge Replacement Form

My name:
I am at:	Earth School TSMS Other
Office or Classroom Number:
My e-mail address:

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Does your printer need a new ink cartridge? Just fill out this handy form and submit it to me.

1. My printer is a: ( Please select . . . ) Epson Stylus C600 Epson Stylus C740 Epson Stylus C777i Epson Stylus C82 HP DeskJet 1220c HP DeskJet 5550 HP DeskJet 940c HP InkJet Cp1700 HP JetDirect 300x HP LaserJet 1022n HP LaserJet 1200 HP LaserJet 4100n HP LaserJet 4600dn Lexmark C534n Lexmark C782dn Lexmark E250dn Lexmark LaserPrinter T520 Lexmark Optra E332n Lexmark Optra M410 Lexmark Optra M412 Lexmark Optra S1255 Lexmark T630 Lexmark Z615 Lexmark Z617 Other
   
   If you selected "Other," type the manufacturer and model of your printer here:


2. Which color ink color cartridge(s) need replacement?
   
   Check all that apply:
   
   Black ink
   Cyan ink
   Magenta ink
   Yellow ink
   All-colors-in-one color ink cartridge

Any other issues? Type them below. Please feel free to abrev. Thanks!


Do you need me to contact you before I handle the issue? No, don't bother. Yes, I need to know.

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