Printer Request Form

I would like to…

Purchase
Evaluate
Have a specialist contact me
Have more information sent

Name

Company Name

Address

City

State

Zip

Phone

Fax

e-mail

Servers installed:

AS400 (iSeries)

NT 4.0

W2K Server

Linux

RS6000 (pSeries)

Unix Host

Domino

S390 (zSeries)

Industry

Manufacturing

Healthcare

Distribution

Government

Retail

Other:

Printer Requested

Printer use: (check all that apply)

General accounting reports

 High quality correspondence
Pre-printed forms Color output
Check printing Other:
Shipping/Receiving documents  

Number of units you could deploy?

1 2-5 6-9 10+

Timeframe for deployment?

Immediate 30 days 1-3 months 4-6 months 6+ months

I heard about these products from…

Direct mail piece

Trade show/seminar

Display ad in magazine

Yahoo/Web search

Referral

Other

Additional Comments