Ink Fulfillment Verification Form

In an effort to ensure the accuracy of our data, we request that any families fitting the following criteria, please fill out the following form.

If you have a student that was enrolled after June 2007.
If you have moved on or after June 2007.
If your printer has been replaced since June 2007.
If you have opted NOT to use a printer issued by the school for your student.
If you have not yet received a working printer.

Please note that we can ONLY send ink for printers issued by the school. If you choose not to use a school issued printer for your printing needs, please indicate "Not using a school provided printer" from the dropdown below.

All fields in this section (except for "Middle Name") are required and must be completed before pressing submit.
Reason for submitting form:
Teaching Adult's Name		Current Shipping Address
First Name:		Street:
Middle Name:		City:
Last Name:		Zip:
Daytime Contact Number:

Student Names: For families with multiple students enrolled, please fill out one section for each printer being used.
Student 1		Student 2
First Name:		First Name:
Last Name:		Last Name:
Student ID#:		Student ID#:
Printer Make:		Printer Make:
Printer Model:		Printer Model:
See a list of shipped models at the bottom of this page.		See a list of shipped models at the bottom of this page.
Student 3		Student 4
First Name:		First Name:
Last Name:		Last Name:
Student ID#:		Student ID#:
Printer Make:		Printer Make:
Printer Model:		Printer Model:
See a list of shipped models at the bottom of this page.		See a list of shipped models at the bottom of this page.
Student 5		Student 6
First Name:		First Name:
Last Name:		Last Name:
Student ID#:		Student ID#:
Printer Make:		Printer Make:
Printer Model:		Printer Model:
See a list of shipped models at the bottom of this page.		See a list of shipped models at the bottom of this page.

List of valid models: The following is a list of printers shipped by K¹² Inc. Use this list when filling out the "Model" field above. If you model is not listed below, the please put "other" and a member of the PAVCS Technology Dept. will contact you.

Canon Printers:	1500, 1600, 2110	Epson Printers:	777, 880, C60, C86
HP Printers:	1200, 1210, 1315, 1350, 1510, 2110, 2300, 2355,3500, 3520, 3740, 3745, 3747, 3930, 3940, 4215, 4280, 4315, 5550, 5610, 5940, 6122, 6540, 6840, 694, 7110, 712, 722C, 7410, 845C, 932, C4280, C5280, D2330, D2430, F4180	Lexmark Printers:	1100, x1150, x3350, x4270, x63, x75, z12, z45