Applicant Details
Product Details
Company Name:
* Name:
Title:
* Telephone:
* Email Address:
Company Address:
City:
State:
Zip Code:
Current Supplier:
(Select One)
Xerox
Canon
Copystar
Gestetner
Konica-Minolta
Kyocera
Muratec
Oce
Panasonic
Ricoh
Riso
Samsung
Savin
Sharp
Toshiba
Other
If other, please specify:
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+
Dealer Sales
Representative:
Additional Information
Where you purchase your supplies (paper & toner)?
Questions/ Comments:
How often do you purchase?
1x per month
every 2 months
2x per year
1x per year
other
