Site Assessment Survey

PART ONE
Contact Information
Department
First & Last Name
Phone Number	Ext
E-Mail Address
Address	Suite Zip

Alternative Contact Name	(person we can talk to if you are not in)
Alternative Phone Number	Ext
Alternative E-Mail Address

If equipment will be delivered to an address different than above please add the address equipment will be delivered to
Address	Delivery Suite Delivery Zip

Will you need us to remove your current copier once new one is delivered?

PART TWO
Equipment Information
Copiers
Current Copier #1		Can you print to it?
Current Copier #2		Can you print to it?
Current Copier #3		Can you print to it?

Which of the following features would you like installed on your new copier?
Stapling Finisher - 3-Hole Punch - Four Full Color - Printing Capability

Do you outsource any color or black and white copy jobs?

If so, are they color or B/W? How often do you have a need to outsource? Can you tell us the amount of copies outsourced monthly? Notes or Comments:

Faxes
Current Fax