Meter Reading Submission

Contact Information

Title

Name

Phone

Customer Reference A reference specified by you that you required Fuji Xerox to use. This is not mandatory.

Individual/Organisation Information

Company Name

Address

Meter Reading Information

Product/Model

Serial Number

Account Number

Machine Address This is the address where the machine is located. Not an accounting or headquarters address.

Additional Information

Meter Reading Machine

Date

Meter 1

Meter 2

Meter 3

Meter 4

Meter 5

Privacy 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.

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