* * *

Enter Your Meter Reads Below

* * * Enter Your Meter Reads Below

Name of Company/Organization

Please provide the name of the company or organization that you are submitting this on behalf of.

Customer Code

Please enter the customer code number that was provided to you.

Monochrome (B/W) Impression Counter

Please input the total number of monochrome (black & white) images for your primary device or combined devices. This should be the sum of all prints and copies. Digits only (no commas).

Color (C) Impression Counter

Please input the total number of color images for your primary device or combined devices. This should be the sum of all prints and copies. Digits only (no commas).

Smartplace Device Identification Number

If applicable, please provide the ID number of the device(s) you are reading and submitting for. Multiple ID numbers should be separated with a comma.

Contracted Device Manufacturer & Model(s)

If applicable, please provide manufacturer and model number(s) for the device(s) you are reading and submitting for. Multiple entries should be separated with a comma.

Your Name

Please provide your name.

First Name

Last Name

Additional Comments/Questions

Please use this area to write in any supplemental information that you think is important, or for providing any questions, comments, or concerns. In the event a response is required, a Smartplace representative will contact your company/organization promptly.