HP 2600fx Optical Disk Drive : User guide : Page 40

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Maintenance Contract: number __________________________________

_____ VISA_____ MASTER CARD

Credit Card Number _____________________________________________________

Expiration Date _________________________________________________________

Signature ____________________________________ Date _____________

Purchase order number:___________________

Billing Address:

________________________________________________________________

Authorized Signature: ___________________________________________

Phone __________________________

What needs to be done?

Describe the conditions at the time of failure. (What were you doing when the failure

occurred? What software were you running? Is the failure repeatable?)

_______________________________________________________________________

Additional comments:

________________________________________________________________

____________________________________

Thank you.