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Multi-Functional Copier Request Form
Company Name
Contact Name
Address
City, State, Zip
Phone
Email
Make and Model Requested
Desired Brand:
SHARP
LEXMARK
BROTHER
SAMSUNG
Options Desired:
Auto Feed
Additional Paper Trays
Duplex
Staple
Hole Punch
Full Color
Faxing
Network Print
Network Scan
11 x 17
12 x 18
Color Scanning
Monthly Volume:
1000 to 3000
3000 to 6000
6000 to 10000
over 10000
Price Range:
Under 1000
1000 to 3000
3000 to 6000
Over 6000
Monthly Lease:
Under 50
50 to 100
100 to 150
Over 150
Service Contract:
Yes
No
Type of Network:
Windows
Mac
Unix
Linux
Number of Workstations:
Less Than 5
5 to 10
10 to 20
Over 20
Time Frame:
Less Than 30 Days
30 to 60 Days
60 to 90 Days
Over 90 days
Preferred Contact:
Phone
Email
Mail
23939 Research Drive Farmington Hills, MI 48335 Ph: 248-426-6200 Fax: 248-427-1909
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