Department Name Phone Email Interested In Please select the option or options that you are interested in. Request a Meeting Copier Usage Summary Report. This is a summary of your copier use for the past 12 months, with a recommendation of a replacement. New/Replacement Copier Order Form Request in person meeting Indicate your location or meet at Research Way and desired day/time. Request Phone Call or Teams contact Indicate phone or Teams, and day/time that works best. Model Location Budget Authority The budget authority is the person with the authority to approve charges to the departments index code. This field is not required unless placing an order. Index and Activity Code Enter the Index Code for monthly billing and the activity code if necessary What Type of Copier? Black and White Color Select both options if interested in Black and White and Color copiers When making a selection of the model or models that you are interested in, please indicate the quantity desired. When a quantity of one or more is selected, five location fields will become available. Please put the location of where you would like to have the printer installed. After inputting the location, some models will present an option to choose to have four paper feed drawers, each with 550 sheets. The other option is to have two drawers with 550 sheets each combined with a single drawer that can hold up to 2000 sheets. BLACK AND WHITE MODELS IM 430Fb - Quantity 012345 $31 per month (networked) or $46 per month (non-networked) Includes 500 copies per month. Additional copies are .0205 per copy Location IM 2500 - Quantity 012345 $65 per month (networked) or $80 per month (non-networked) Includes 1,000 copies per month. Additional copies are .0205 per copy Location IM 5000 - Quantity 012345 $110 per month (networked) or $125 per month (non-networked) Includes 1,000 copies per month. Additional copies are .0205 per copy Location IM 6000 - Quantity 012345 $149 per month (networked) or $164 per month (non-networked) Includes 1,500 copies per month. Additional copies are .0205 per copy Location IM 7000 - Quantity 012345 $197 per month (networked) or $212 per month (non-networked) Includes 1,500 copies per month. Additional copies are .0205 per copy Location COLOR MODELS IMC 300F - Quantity 012345 $46 per month (networked) or $61 per month (non-networked) Includes 500 black and white copies per month. Additional B/W copies are .0205 per copy Color copies are charged at .123 per copy Location IMC 2510 - Quantity 012345 $92 per month (networked) or $107 per month (non-networked) Includes 1000 black and white copies per month. Additional B/W copies are .0205 per copy Color copies are charged at .123 per copy Location IMC 3510 - Quantity 012345 $133 per month (networked) or $148 per month (non-networked) Includes 1000 black and white copies per month. Additional B/W copies are .0205 per copy Color copies are charged at .123 per copy Location IMC 4510 - Quantity 012345 $139 per month (networked) or $154 per month (non-networked) Includes 1500 black and white copies per month. Additional B/W copies are .0205 per copy Color copies are charged at .123 per copy Location IMC 6010 - Quantity 012345 $175 per month (networked) or $190 per month (non-networked) Includes 1500 black and white copies per month. Additional B/W copies are .0205 per copy Color copies are charged at .123 per copy Location Is the copier replacing another copier? Yes No Equipment ID Number Equipment ID Number Model Location (if different) Comments
