* Company Name:

* Title:

* Telephone:

* Email:

* Company Address:

* City:

* State:

* Zip Code:

* Current Supplier:

If other,

Approximate current lease term expiration

B&W Copy Volume

B&W Print Volume

Color Copy Volume

Color Print Volume

Where do you currently purchase your supplies (paper & toner)?

How often do you purchase supplies?

* Xerox Sales Representative:

Questions/
Comments: