Return Form

ES3640 MFP Gas Spring Upgrade Program

For the Return of the Original Gas Springs:

Use this form for each set of ES3640 product gas springs replaced and follow the instructions to complete the form and return the old gas springs. If you require another copy of this form please contact the number below and we will immediately send you another form to use.

INSTRUCTIONS

A.  Using the tool kit supplied separately, install the new set of gas springs (and additional parts as identified) per the supplied instructions. Note: The new gas springs are identified by a blue ½ inch stripe located at the top of the spring.

B.  Repackage the original gas springs in the box that the new springs were supplied.

C.  Complete lines 1, 2, 3 & 4 below before contacting Oki Data.

D.  Upon completion, you can (a) fax a copy of this form to 856-222-5247 and the contact listed below will be called next business day and given an RA # to be filled in line 5 below; or (b) call the RGA helpdesk at 800-654-1000 - Option 5 between 8am to 6pm Eastern Time.

E.  Place the COMPLETED Pink copy of this form inside EACH box with the original gas springs being returned to Oki Data.

1.  Dealer Number

2.  Dealer Name

3.  Contact Phone:

4.  Model No. Serial No. off Printer: 1 per sheet

5.  R A # assigned by Oki Data: (add to shipping box)

Ø  After receipt of the fax or phone call to Oki Data, we will overnight to you the next business day, the required air-bills to your office location to the contact above, for the return of the old gas springs.

Notes:

·  The new replacement gas springs have a ½ inch round blue stripe at the top end of the piston. The old style does not. Inspect the gas springs to be returned to insure you are returning the original gas springs, and they have been packaged in the box provided.

·  Please do not fax this form until you have replaced the original gas springs and you are ready to have them returned.

·  Make sure to return the pink copy of this form with each return shipment and keep the white copy for your records. Delaying this process may cause delay in the proper reimbursement. See FAQ document for more details.

·  Reimbursement rate is based on carrier pick-up date and verification.

Top-white for Dealer to keep on file. Bottom-pink to Return with package

PN 58382201