Copiers Worldwide, Inc.
P.O. Box 10036   Chicago, IL.   60610   Phone:312-944-8383   Fax:312-944-3593
Fax Machine Survey
After filling out survey, please print and fax to us. Thank You!

• Please provide the following contact information:

  Company Name:
  Your Title:
  Street Address:
  City:
  State:	Zip:
  Business Phone:
  FAX:
  E-mail:

• Please provide the following product information:

• Current Model:                                                   A.B.Dick Company Brother Canon Copystar Kodak Konica Lanier Minolta Mita Okidata Olympic Omnifax Other Panasonic Pitney Bowes Ricoh Royal Copystar Savin Sharp Toshiba Xerox

• Model Number:                                                                           

• Tell us the age of your fax machine:                      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 fax machine:  New Remanufactured Refurbished Used As Is
  
  

• Are you unhappy with your current fax machine? Explain:

• How much do you pay for replacement cartridges?:  

We will contact you, to further discuss your fax machine needs. Thank You!