Name
               Company
                 Email
      Installation Zip
                 Title
                 Phone
          Email Opt In Yes No

                     

        Purchase Date Today Within 3 Days This Week Next Week Within 30 Days Within 6 Months Other
    Payoff Funds Needed Show As Option
         Machine Type COLOR Copier/MFP B&W Copier/MFP Printer Scanner Fax
   Required Functions Copy Print Scan Fax 
  Select Output Speed Up to 20 Pages Per Minute 25 Pages Per Miniute 30 Pages Per Minute 35 Pages Per Minute 40 Pages Per Minute 50 Pages Per Minute 60 Pages Per Minute 80 Pages Per Minute
Select Monthly Volume 2,000 Pages Per Month 3,000 Pages Per Month 5,000 Pages Per Month 7,500 Pages Per Month 10,000 Pages Per Month 12,500 Pages Per Month 15,000 Pages Per Month 20,000 Pages Per Month 25,000 Pages Per Month 50,000 Pages Per Month
 Minimum Paper Supply 300 Sheets 550 Sheets 1,050 Sheets 2,050 Sheets 4,050 Sheets 8,150 Sheets Show As OPTION
 Finisher/Sorter Type None Simple Finisher (Single Position Stapler 25 Page Sheets/1K Capacity) Full Function Finisher (50 Page Stapling/3K Capacity) Show As OPTION
       2/3 Hole Punch None Standard Option
        7 Bin Mailbox None Standard Option
       Booklet Folder None Standard Option

  Intelligent Capture None Basic Advanced Show As OPTION
  Document Management None Professional Edition Small Business Edition Corporate Edition Enterprise Edition Enterprise Content Management Edition Show As OPTION
    Lease OR Purchase 60 Month Lease 48 Month Lease 36 Month Lease Purchase Credit Card
  Comments/Questions: