No

Own

Lease

N/A (You do not currently have a machine.)

What Make/Model Machine are you looking to upgrade?

Do you currently own or lease it?

What type of machine are you interested in?

Multifunction Machine. (COPY/PRINT/SCAN/FAX)

Black and White Copier

Color Copier

Fax Machine

Black and White Laser Printer

Color Laser Printer

Shredder

Other

One

Two

Three or more

How many machines are you looking for?

If three or more, please note exact quantity:

15 to 20 pages per minute

21 to 30 pages per minute

31 to 45 pages per minute

What speed of machine are you looking for?

46+ pages per minute

Low Volume (Less than 3,000 copies per month)

Medium Volume (3,000 - 10,000 copies per month)

What is your projected monthly volume?

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? (please check all that apply)

8 ½ by 11 (Letter)

8 ½ by 14  (Legal)

11 by 17 (Tabloid)

All of the above sizes

Yes

Do you use heavy paper weights?

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

Yes

No

Would you like information on a Maintenance Agreement?

ASAP

In Two Weeks

In One Month

When would you require delivery?

Other

If other, please specify a time:

36 month lease

48 month lease

What purchase option do you desire?

60 month lease

Credit Card

Outright Purchase

On Account

Is there any addition information you would like to let us know?

Contact Information

*Telephone:

*Email:

*Name:

Company Name:

Verification Image:

Enter Verification Image:

(only 6 lower-case letters)