Xerox - Printer Service Request
Clinic Name
Clinic Address
Clinic City
Clinic State & Zip Code
Clinic Account Number
Optional - This can be found in Salesforce under the My Clinic -> Account Detail tab.
Contact Name (First & Last)
Contact Email
Contact Phone (###-###-####)
Model # (front of Printer)
Serial # (back of Printer)
Type of Request
Printer Service Needed
Printer Software Support
Printer Return
Printer Move
Additional Printer Needed at Current Location
Other
Brief Description of Issue
Clinic Closing Date (if applicable)
Indicate the last date someone will be at the clinic to handle the return
New Clinic or Location Name
Indicate the clinic or location the printer is moving TO
New Clinic Account Number
Optional - This can be found in Salesforce under the My Clinic -> Account Detail tab.
New Address
New City
New State and Zip Code
NOTE: If you need Printer Supplies (toner, etc) - please use this form instead:
Printer Supplies Request
Comments / Notes
Add any additional details here that can help clarify your request.
All required fields must be completed before submitting.
Xerox will respond to all requests within 8 business hours.
Printer Replacements, Printer Returns, and Additional Printer Requests will be processed within 2 - 3 business days.
If you have any questions regarding an existing Service Request, please call Xerox Support at (800) 978-2396.
Contact Information