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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 and White Copier
Color Copier
Fax Machine
Black and 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:

What purchase option do you require? 36 month lease
48 month lease
60 month lease
Outright Purchase

Is there any additional information you would like us to know:

Contact Information

Company Name:
* Name:
* Email:
* Telephone:
Address:

City:
State/Region:	Zip/Postal:

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