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Company Name
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Phone Number (required)

Product Information

What Make/Model Machine are you looking to upgrade?
Do you currently own or lease it?
 Own Lease N/A (You do not currently have a machine)

What type of machine are you interested in?
 Multifunction Machine (COPY/PRINT/SCAN/FAX) Black & White Copier Color Copier Fax Machine Black & White Laser Printer Color Laser Printer Other
How many machines are you looking for?
 One Two Three or More
If three or more, please note exact quantity:
What speed of machine are you looking for?
 15 to 20 pages per minute 21 to 30 pages per minute 31 to 45 pages per minute 46+ pages per minute
What is your projected monthly volume?
 Low Volume (Less than 3,000 copies per month) Medium Volume (3,000 - 10,000 copies per month) High Volume (10,000 - 30,000 copies per month) Very High Volume (30,000+ copies per month) Not Sure
What paper sizes do you require?
 8 1/2 by 11 (letter) 8 1/2 by 14 (legal) 11 by 17 (tabloid) All of the above sizes
Do you use heavy paper weights?
 Yes No
What multifunctional product functions needs do you require?
 Color Printing Scanning Faxing E-mailing Document Storage and Retrieval No additional functions, we will just be making copies Not Sure
Would you like information on a Maintenance Agreement?
 Yes No
When would you require delivery?
 ASAP In Two Weeks In One Month Other
If other, please specify a time:
When would you require delivery?
 36 month lease 48 month lease 60 month lease Outright Purchase
Is there any additional information you would like us to know:

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