Copier Quote Request

    Please provide the following contact information:

    First Name
    Last Name
    Title
    Organisation
    Street Address
    Address (cont.)
    City
    State
    Postal Code
    Phone
    FAX
    E-mail

    Are you interested in: Black Colour
     

    Do you currently have a Photocopier? Yes No
     

    If so, enter the Brand in the following space.

    What options does it currently have?
    Document Feeder
    Duplex Unit
    Sorter
    Stapler
    Punch
    Other

    Is it currently networked? Yes No

    Do you wish to be quoted on a similar size unit?
    Yes      Larger   Smaller 
     

    Approx How many copies do you make per month?

    Current Meter Reading:

    How long have you owned Machine:

    For what purpose will your New System be used?



    What Options do you require?
    Printer
    Interface
    Networking
    Document Feeder
    Stapler
    Sorting
    Duplex
    Punch
    Folding
    Other

    Do you require Leasing, Rental or Outright Purchase pricing:
    Leasing            Rental             Outright Purchase 
     

    Do you require Delivery and Installation to your site?
    Yes No

    If so, to What Address will the machine require to be located?

    Are there any other comments or additional information you think we need to know?


    Signature:   

    Date:            -- dd/mm/yy