*Required FieldsContact Details Salutation Dr Miss Mr Mrs Ms First NameLast NameCompany Legal NameEmail AddressPrimary Contact NumberSecondary Contact NumberBlock/House number and Street NameUnit NumberBuildingPostal Code Product Details Place of Purchase01 Computer System Pte Ltd AK Global Tech Pte Ltd Albony Integration Services Pte Ltd Apac System Pte Ltd Ardent IT Pte Ltd Asiacloud Solutions Priviate Limited Bescom Computer System Pte Ltd Bits & Bytes Marketing Pte Ltd Bizgram Asia Pte Ltd Century Office & Gift Supplies CJ Enterprise Pte Ltd Clover Global Pte Ltd COE Marketing (S) Pte Ltd Computer Analysts & Recovery Experts Pte Ltd Courts (Singapore) Pte Ltd CSS Office Solutions Pte Ltd Deskright Pte Ltd Dots Technology & Trading Evergreen Group Pte Ltd Flexitech Pte Ltd Fuji Xerox Singapore Pte Ltd Global IT Mart Pte Ltd Ideal Technology (S) Pte Ltd Innocom Technologies Pte Ltd JK Technology Pte Ltd Kumpulan Development (s) Pte Ltd Majulah Office Equipment Pte Ltd Managed Print Solutions Pte Ltd Mediapro Technology Pte Ltd MGR Office Solutions Pte Ltd Nikko Group Pte Ltd Nordic Solutions (Asia) Pte Ltd Oregon Prime Marketing (International) Pte Ltd Pearlblue Tech Pte Ltd Popular Book Company Pte Ltd S2 Computer Supplies Pte Ltd Sky 9 Innovation Pte Ltd Strategic Netbiz Pte Ltd TAK System Integration Pte Ltd Tech Digital Pte Ltd Xenetix Pte Ltd Others Date of Purchase 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2015 2016 2017 2018 2019 2020 2021 Product Model NumberDocuPrint P285 dw DocuPrint M285 z DocuPrint CP315 dw DocuPrint CM315 z DocuPrint P375 dw DocuPrint M375 z DocuPrint CP405 d DocuPrint CM405 df DocuPrint P455 d DocuPrint M455 df DocuPrint P475 AP DocuPrint CP475 AP DocuPrint 3205 d DocuPrint 3505 d DocuPrint 4405 d DocuPrint C5155 d ApeosPort-VII C3321 ApeosPort-VII 4021 ApeosPort-VII C4421 ApeosPort-VII 5021 ApeosPort Print C5570 Product Serial NumberProduct Warranty PeriodNote: If there is any discrepancy with the warranty period offered, please contact our service hotline at +65 6766 8888 or email us at fxs.support@sgp.fujixerox.comInvoice NumberPromotion Code If Any I have read, understood and agree to the Terms & Conditions Terms & Conditions Yes, I give my consent to FUJIFILM Business Innovation Asia Pacific Pte Ltd to contact or keep me updated of FUJIFILM Business Innovation printers’ contests, promotions and latest developments