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(Your information will NOT be shared with any third party companies)
* Current Equipment Supplier:
(Select One)
Brother
Canon
Copystar
Duplo
Fujitsu
Gestetner
HP
KIP
Konica-Minolta
Kyocera
Lanier
Lexmark
MBM
Muratec
NEC
Océ
OKI
Panasonic
Ricoh
Riso
Samsung
Savin
Sharp
Standard
Toshiba
Xerox
Other
If other,
Approximate current lease term expiration
B&W Copy Volume
0
1-3,000
3,001-6,000
6,001-9,999
10,000+
B&W Print Volume
0
1-3,000
3,001-6,000
6,001-9,999
10,000+
Color Copy Volume
0
1-3,000
3,001-6,000
6,001-9,999
10,000+
Color Print Volume
0
1-3,000
3,001-6,000
6,001-9,999
10,000+
Where do you currently purchase your supplies (paper, toner, and staples)?
How often do you purchase supplies?
---
1x per month
several times per month
every 2 months
2x per year
1x per year
included in current contract
other
Do you know who your sales representative is?
--
Yes
No
Sales Representative's Name
Company Information
* Company Name:
* Your Name:
* Title:
* Telephone:
* Email:
Questions/ Comments:
Verification Image:
Enter Verification Image:
(only 6 lower-case letters)
