Copiers Worldwide, Inc.
P.O. Box 10036   Chicago, IL.   60610   Phone:312-944-8383   Fax:312-944-3593
Copier Survey

• Please provide the following contact information:

  Company Name:
  Your Title:
  Street Address:
  Address (cont.):
  City:
  State:
  Zip Code:
  Business Phone:
  FAX:
  E-mail:

• Please provide the following product information:

  Current Copier:	Canon Konica Minolta Mita Olympic Panasonic Pitney Bowes Ricoh Savin Sharp Toshiba Xerox Other
  Model Number:

• Tell us the age of your unit:   less than a year One Year Old Two Years Old Three Years Old Four Years Old Five Years Old Six Years and Older

• Status of Ownership:   Own Current Unit Rent Current Unit Lease Current Unit
  

• Tell us the original condition of your unit::  New Remanufactured Refurbished Used As Is
  

• Meter Reading on Copier:  

• Are you unhappy with your current unit? Explain:

• How many copies do you estimate making in an average month:   1 to 100 copies 100 to 300 copies 300 to 900 copies 900 to 1500 copies 1500 to 3000 copies 3000 to 5000 copies 5000 to 9000 copies 9000 to 15,000 copies 15,000 and more copies

We will contact you, to further discuss your copier needs and your demands from your copier.