* Current Equipment Supplier:	(Select One) Brother Canon Copystar Duplo Fujitsu Gestetner HP KIP Konica-Minolta Kyocera Lanier Lexmark MBM Muratec NEC Océ OKI Panasonic Ricoh Riso Samsung Savin Sharp Standard Toshiba Xerox Other
If other,
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+
Where do you currently purchase your supplies (paper, toner, and staples)?
How often do you purchase supplies?	--- 1x per month several times per month every 2 months 2x per year 1x per year included in current contract other
Do you know who your sales representative is?	-- Yes No
Sales Representative's Name

Company Information

* Company Name:
* Your Name:
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