Page Count Report Form

Ricoh Printing Systems America, Inc

Customer Services

Meter Count Reporting

Please enter your information here. All information must be filled out.

Contact (Your Name)


Customer Name (Your Company's Name)


Fax Number		Date Sent

Format ex: 805-578-3344		ex:mm,dd,yyy


Your Ricoh Printing Systems America, Inc. Warranty/Service Agreement is based upon a maximum number of printed images per month. Usage over that rate is subject to a click charge. This document will be used to determine your monthly usage. Any resulting charges will be billed separately. If we do not receive this form by the fifth working day of the following month, you will be invoiced for click charges for 15,000 pages over the monthly maximum pages allowed for your printer.

Model	Serial Number


Purchase Date	Current Month Reading Date
/ /	/ /
Format ex: M/D/Y 7/02/01	Format ex: M/D/Y 7/02/01

Last Month's Reading	Current Month's Reading


Reading Reported by (Your Name)