Your Name:             Your Title:

Company Name:      Company Street Address:

City, State, Zip:        Your Phone Number:

Your Email:

Number of employees: 1 2-5 5-20 20-100 100-500 500-1500 1500+                Industry Type: Health Care Gov't/Public/Civil Service Manufacturing/Engineering Transportation/Shipping Finance/Banking/Investing Non-Profit Religious Technical Service & Support Engineering/Architechture Technology Education Entertainment/Art Construction Real Estate Legal Other   

Specifics of interest:

What type of equipment are you seeking information on?                  copier shredder duplicator fax printer scanner multiple

Multi-functional use desired? (faxing, network faxing, printing, scanning)              yes no

Do you need to make color copies/prints, too?                                 No Yes

Are you interested in a particular model?                                         

Number of machines you may be interested in:                                 1 2-4 4-8 8-15 15+  

Approximate number of copies/prints per month?                             1-2500 2500-5000 5000-10,000 10,000-25,000 25,000-50,000 50,000-150,000 150,000+

Approximate machine speed desired?                                              up to 20 pages per minute 20-29 pages per minute 30-39 pages per minute 40-49 pages per minute 50-80 pages per minute 80-120 pages per minute 120+ pages per minute

Will the machine(s) be connected to a computer or network?               no yes

Would you like information on leasing options?                                            no yes

What is your budget for this purchase?                                                           $500-$1000 $1000-$3000 $3000-$5000 $5000-$10,000 $10,000-$25,000 $25,000-$50,000 $50,000+

When would you need the equipment?                                             A.S.A.P. within 15 days within 30 days within 90 days 90 days +

Would you like information on Service Agreement options?              yes no

What paper sizes do you use?

    Letter (8 1/2 X 11)

    Legal (8 1/2 X 14)

    Ledger (11 X 17)

    Statement/Invoice (8 1/2 X 5 1/2)

    Other - please describe:

Special features desired? - please describe:

Any other notes or comments?