*Company Name

*Onsite Sales Request No Yes

*Contact Name

*Street Address

*Telephone

*Email

*Printer Interested In?

*Do You Wish to Own or Lease? Own Lease

*Select the Type of Machine Multifunction Copy/Print/Scan/Fax Black & White Copier Color Copier Fax Machine Black & White Laser Printer Color Laser Printer Solid Ink Printers

*# of Machines Required? One Two Three or More

If More Than Three, Please Note Type & Quantity:

Print Speed You Need? 15 to 20 pages per minute 21 to 30 pages per minute 31 to 45 pages per minute 46+ pages per minute

Your Print Volume? Low Volume (Less than 3,000 copies per month) Medium Volume (3,000 to 10,000 per month) High Volume (10,000 to 30,000 per month Very High Volume (30,000+ copies per month) Unsure, I could use help in determining our volume

Paper Size Needed? 8 1/2 X 11 (letter) 8 1/2 X 14 (legal) 11 X 17 (tabloid) All Of The Above Sizes

Do You Use Heavy Weight Papers? Yes No

Select Functions You Require: Color Printing Scanning Faxing Emailing Document Storage & Retrieval No Additional Functions Req.

Maintenance Agreement? No Yes

Interested In Managed Print? No Yes

Date Equipment Needed

Purchase Options: 36 Month Lease 48 Month Lease 60 Month Lease Credit Card Cash Sale

Is There Any Other Information You Would Like Us To Know?

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