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                         Multi-Functional Copier Request Form


  Company Name 

  Contact Name 
 
  Address 

  City, State, Zip 

  Phone 

  Email 


  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:      Price Range:


  Monthly Lease:     Service Contract: 

 
  Type of Network:    Number of Workstations: 

 
  Time Frame:     Preferred Contact: 


                                             
 
 
 
23939 Research Drive     Farmington Hills, MI 48335     Ph: 248-426-6200     Fax: 248-427-1909
 
 
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