Name:
E-Mail:
Re-Enter E-Mail:
Your Order Number:
Product(s) You Ordered:
Machine Manufacturer: (e.g. Brother, HP, Xerox, etc.)
-- Most Popular Brands --
Apple
Brother
Canon
HP/Hewlett Packard
Lexmark
Samsung
Sharp
Xerox
-- all brands --
AB Dick
ABC Professional
ACER
Acom Computer
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Adler/Royal
Advanced Tech International
Advanced Vision Research
Aedex
AGFA
Aitell
Alcatel
Allied Linotype
Alphatext
Alps
Alwright
American Printing Technology
Ampak Business Systems
Amstrad
Analog Technology
Anzac Computer Equipment
Apple Computer
Applied Computer Science
Apricot
Aptec
Arkwrite
Asmarc
AST
AT Systems
AT&T
Atlantic Research
Autographix
Autologic
AVR
Basic Four / MAI
BDS Computer
BDT
Bedford Computer Systems
Bell & Howell
Berthold
Bezier
BGL Technology
Binder LaserGraphix
Birmy Graphics
Blaser
Bosch
Bottomline Technology
Brother
Burroughs / Unisys
Business Systems International
C Itoh / C-Tech
CAF Computer
Calcomp
Camintonn
Canon
CDS
Chameleon
Check Technology
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Citizen
Commodore
Compaq
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Compuprint / Honeywell Bull
Computer Language Research
Comterm
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Concorde
Copystat
Cordata
Corona Data Systems
COT
CPF
CPT
Daikin Industries
Data General
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DEC / Digital Equipment
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Derex
Desktop Systems
Detewe
Develop
DEX Business Systems
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Digital Design
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Docupoint
Eastman Kodak / Danka
ECRM
Efax / Jetfax
EFS
Eicon
Electronic Forms System
EPS
Epson
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Esselte
Everex
Facit Industries
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GBT
GEHA
General Business Technology / GBT
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Hamilton
Hanzon
Harris / Lanier
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Hermes
Hewlett Packard / HP
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Hitachi
HOB
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Imagen
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Inform Technology
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Intek
Interface / Intergraph Systems
Interkom
Interleaf
International Telephone and Telegraph / ITT
ITEC /Newgen
Itek Composition Systems
Iverson
JBCC
JPS
JRL Systems
KEL
Kidron
Kienzle
KLI
Konica
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Lanier / Harris
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Lee Data
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Lexmark
Lienzle
Linotype
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Mannesman Tally
Marquette Holter
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Melchers
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Micropartner
Minolta
Mirror Tech
Mita
Mitac
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Moore Business Forms
Muratec
Murata
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NCR
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NBI
NBS Southern Systems
NEC
Newgen
Next
North Atlantic
Not Listed
Novus
Oasys
OCE
Octave Systems
Office Automation Systems/OASYS
Okidata
Olivetti
Olympia
Omnifax
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Osicom
Pacific Semi
Packard Bell
Panasonic
Parris
PBH
PCs Limited Lasersystems
PCPI
PERQ Systems
Personal Computer
Philips
Pitney Bowes
PNC
Pragma
Prepress Solutions
Prime Computer
Prinserter
Printer Systems
Printerm
Printers Plus
QMS
Quadram
Qubix
Quickor
Quill
R2D2
Radio Shack
Raster Devices
Raven
Realtech
Rein
Renful
Rental Research
REX
Ricoh
Rise Technologies
Roland
Roneo-Alcatel
Rosetta Technologies
RT & C
Sagen
Samsung
Sanyo
Savin
Schneider
Selex
Sharp
Shinada
Siemens
SIHL Gmbh
Sony
Source Technology
Special Printing Solutions
Speed-o-print
SRS Imaging
Star Micronics
STI
Summit Software
Sun Express
Sun Microsystems
Syntrex
TAB
Takaoka Electric
Talaris Systems
Tandem Computers
Tandy / Radio Shack
TEC (tandem)
Tektronix
Teleautographic
Telekom
Telenorma
Telesystems
Telex
Texas Instruments
Teket
Toshiba
Troy / Data Card
Truetech
Unidot
Unlisted
US Laser
US Lynx
Utah
Varityper
Viewtech
Wallace Computer Services
Wang
WDV
Wenger
Xante
Xerox
Xitron
XLI
Xyvision
Zerox
Zygal
Machine Model Number:
(e.g. LaserJet 5P, PC720, XD865, etc.)
General Problem Category:
(Pick the one that best describes your printing problem)
Regulary repeating dots, spots, lines on page
Randomly occuring spots, dots, lines, etc.
Heavy dark lines along margin(s) of page
Light, faint, blank vertical streaks on page
Sharp vertical lines on page
Gray haze over most of the page
Overall faint or light print on page
Portion of page prints fine, other portion too light
Abnormal clicking, pop, squeak or other noise
Machine still says toner low, toner empty, etc.
Other problem not listed here
General Problem Status:
(General assessment of problem with continued printing)
Getting better with continued printing
Staying the same over time
Getting worse over time
Unsure if getting better/worse
Name-Brand or Generic:
(Was this a name-brand, never-remanufactured empty or a generic/remanufactured cartridge)
Name-brand OEM original (Brother, Canon, Xerox etc.) empty
Remanufactured (OfficeDepot, local remanufacturer, etc.)
Not certain
How many pages printed:
(approximate number of pages output so far since refilling)
0 - 10
10 - 25
25 - 50
50 - 100
100 - 500
500 and up
How many refills to date:
(Has this cartridge been refilled before, if so, how many times)
First time
Second time
Third time
Fourth time
More than four times
When did the problem start:
(Select the time the problem
began to appear)
Before the cartridge was even empty or refilled
Immediately after refilling the cartridge
A few days after refilling
A few weeks after refilling
Not certain
Did you try another cartridge:
(If you have another, non-refilled cartridge and tried it in the machine without refilling it first, select the appropriate response and Tab to the next and final field)
Tried another cartridge - problem went away
Tried another cartridge - problem remained
Don't have another spare cartridge to try
Not applicable
Problem/Concern/Question:
Add any details you feel weren't covered above or clarify any answers. Additional detail is appreciated and helps diagnose the problem and allows us to provide a more accurate answer.
DO NOT PRESS SUBMIT UNTIL YOU VERIFY ALL FIELDS HAVE BEEN FILLED IN
(Failure to do so will necessitate starting over from the very beginning.)