Contact Information TitleMr Mrs Ms Miss Dr Khun Other NamePhoneEmailCustomer Reference Individual/Organisation Information Company NameAddress Meter Reading Information Product/ModelSerial NumberAccount NumberMachine Address Additional Information Meter Reading Machine DateMeter 1Meter 2Meter 3Meter 4Meter 5Privacy Statement I represent and warrant that I have the authority to provide the information submitted in this form (including information in any attachments) to Fuji Xerox Philippines, and I give my consent for such information to be stored, used and/or disclosed by Fuji Xerox Philippines for the purpose of investigating and/or responding to my inquiry/request. I acknowledge that I have read, understood and/or have been duly informed of the terms and conditions pertaining to the data privacy practices of the Fuji Xerox as reflected in the Fuji Xerox Data Privacy Policy at https://www.fujixerox.com.ph/en/Privacy-Policy and I hereby express my full conformity thereto.Captcha