RICOH Copier Or Printer Refund Request

Repro Graphics Copier/Printer Re-Value Request

Print Name: ______

Address: ______

Phone Number and E-mail : ______

Amount requested ______

Reason for request: ______

______

Repro Graphics Copy Card number ______Attach a copy of your receipt if you did not get credited for money added to, or used to purchase the card.

Machine Location and/or number at which problem occurred: ______

Time at which problem occurred: ______

Signature: ______Date: ______

Instructions: Copiers/printers/scanners, and copy card dispensers are managed by UC Davis Repro Graphics. Please fill out this form, giving as complete information as possible, including the location of the machine where you experienced a problem.

 Mail or bring this form to the Repro Graphics main office at 3820 Chiles Road

In any of the General Library buildings, you may also drop the form off at a Circulation Desk to be faxed to Repro Graphics (754-0200)

Repro Graphics will notify you of the disposition of your request. Repro Graphics staff will process requests as soon as possible (requests may require several days if the contents of a copier must be verified).

If you have any questions please call (530) 754-2127 or e-mail [email protected]

Rev. 7-11-08

Office Use Only Faxed Date: ______Staff Initials: ______Repro Response Date: ______