Epson cash back offer on selected laser printers
Title First name
Daytime telephone number
Date of purchase
Printer serial number
Indicate the product
Model amount Quantity
you are claiming for
AcuLaser M2000D / DT £50
AcuLaser M2000DN / DTN £75
EPL- N2550 series £100
EPL- N3000 series £100
AcuLaser C4200DN series £100
AcuLaser M4000 series £150
AcuLaser C9200 series £200
We may use the information you have provided to send you details about similar Epson products, services or offers.
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Claim checklist. Please supply:-
1 Completed claim form (this sheet)
2 Original proof of purchase (not proof of order). Your original proof of purchase will be returned to you with your
cash back cheque.
3 Please indicate below by ticking the relevant box if you are a VAT registered company.
Please tick here if you are a VAT registered company
The self-billee with the above stipulated VAT registration number agrees:
1) To accept invoices raised by the self-biller on their behalf for this offer
2) Not to raise rebate invoices for the transaction covered by this offer
3) To notify the self-biller immediately if they
i) change their VAT registration number ii) cease to be VAT registered iii) sell their business or part of their business.
If you agree to the above terms and conditions please sign and date below. We regret if you have failed to
sign and date this declaration we are unable to process your claim.
Please send to:
‘Laser Printer Cash Back Offer’, Epson (UK) Ltd. Campus 100,
Maylands Avenue, Hemel Hempstead, Hertfordshire. HP2 7TJ, United Kingdom.
Please note Epson must receive your claim within 30 days from the date of purchase.
Company details on the claim form must be the same as on the proof of purchase.