Xerox FreeColorPrinters Program Application

Contact Information

First Name

Last Name

Work E-mail

Confirm E-mail

Job Title

Please specify:

Contact Phone

- - ext:

Secondary Phone

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Fax

- -

Best Time to Contact

Your Organization

Organization Name

Doing Business As (DBA)

Type of Organization

Corporation

Proprietorship

Partnership / L.L.C.

Non-Profit/Other

Industry

Years in Business

Number of Employees

Approximate Annual Gross Revenue

Website

Federal Employee Tax ID

Street Address

Address 2

City

State

ZIP Code

Type of Address

My shipping address and business address are the same

Ship Address

Ship Address 2

City

State

ZIP

Type of Shipping Address

Printing Environment

Estimate the number of pages you would print per month on the Phaser 8560 color printer for each of the following categories. (1 ream of paper = 500 pages)

Need help?

Contact an advisor at
1-866-890-2168 or chat now.


	Desktop Publishing (newsletters, pamphlets)
	Reports/Proposals (text, graphs/charts)
	Forms (order forms, invoices)
	Sales Materials (brochures, flyers)
	Graphic Arts Proofs (layouts, comps)
	Legal Size Documents (8.5 x 14 inches)
	Presentations (transparencies, handouts)
	Other (spreadsheets, email, letters)
	Projected monthly page commitment:

Percentage of Color Prints

Current Estimated Monthly Printing Expenses

Brands of printers you currently have: (Check all that apply)

Hewlett Packard

Lexmark

Minolta/QMS

Epson

Canon

Dell

Xerox

Other

How do you plan on using the Phaser 8560 color printer?
(300 character max)

Other

Are you working with a Xerox dealer?

Yes No

Credit card used for program

Visa / Mastercard

Amex

None

Yes, I am authorized to accept a FREE color printer from Xerox on behalf of my organization.

Yes, please keep me informed about occasional special offers and new Xerox office products.

How did you hear about us?

Referral/Program Code

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Xerox FreeColorPrinters Application

Typical Member Profile

Program Benefits

Contact Information

Your Organization

Printing Environment

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