Request Form

Please provide the following contact information:

Name
Organization
Work Phone
FAX
E-mail

Please provide the Copier Brand & Model:

Brand/Model No.

Please provide the ADF information:

Model No. or description

Please provide the Finisher information:

Model No. or description

Do you need Dupexing Unit ?

Duplexing Unit

Yes No

Do you need Extra Paper Cassette ?

Extra Paper Cassette

One more Two more Three more

Please provide the Paper Deck information:

Paper Deck Model No. or description

Do you need Cabinet ?

Cabinet

Yes No

Please provide any optional accessories information:

Other option

Please provide how many supplies you need.

Supplies

Please provide the Printer information if you need Print System:

Operating system

Please provide Network information if you need Network Printing:

OS and Unit Number

Where is the customer location ?

Location

Please provide any other information:

Other