First Name

Last Name

Address

Phone No

Email

Make

Model

Meter Reading
Black and WhiteColor (If Applicable)

Drawers

How is your machine configured? Please check all that apply
 Copy Print scan fax Autodocument Feeder Large Capacity Tray

 Finisher
If yes please specify its capabilities and model if known

 Fiery
If yes please specify its capabilities and model if known