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Please FAX this form to: 1-800-760-2200 Or mail the form to: CANON COMPUTER SYSTEMS, INC. DEPT BJC E-REG P.O. BOX 430903-9900 EL PASO TX 88543-9900 Please do not send a cover page with this fax. ---------------------------------------------------------------------------- Form ID: $(Registration.400,12) Q1.... Name (First/Init/Last): $(Registration.201,14) $(Registration.202,1) $(Registration.203,16) Company Name: $(Registration.204,30) Address1: $(Registration.213,30) Address2: $(Registration.214,30) City, State, Zip: $(Registration.215,17), $(Registration.216,2) $(Registration.217,6) Country: $(Registration.218,20) Address Code: $(Registration.101,1) Address Type: $(Registration.102,1) Home Phone: $(Registration.219,3)$(Registration.220,7) Fax Phone: $(Registration.209,3)$(Registration.210,7) Bus Phone: $(Registration.206,3)$(Registration.207,7) Email Address: $(Registration.223,50) Q2.... Date of Purchase (Month/Day/Year): $(Registration.224,6) Q3.... Model #: $(Registration.252,20) Serial #: $(Registration.1434,15) Q4.... $(Marketing.3000,30) Q5.... $(Marketing.1000,10) Q6.... $(Marketing.1010,24) Q7.... $(Marketing.6000,36) Q8.... $(Marketing.6010,36) Q9.... $(Marketing.1020,12) Q10.... $(Marketing.6020,38) Q11.... $(Marketing.3010,28) Q12.... $(Marketing.1300,36) Q13.... $(Marketing.6030,60) Q14.... $(Marketing.6040,36) Q15.... $(Marketing.1030,12) Q16.... $(Marketing.6050,36) Q17.... $(Marketing.6060,36)