User account

Copier Request Questionnaire

Are you ready to save 75% on your next copier purchase?
If so you are on the right page. This Copier Request Questionnaire is the first step in the process of finding you the best copier, fax or printer at the best price. Please fill out this form and let me know what type of office equipment you are interested in. This form creates a customer profile that I can use to research and find the best piece of equipment for you. All your information is private and will only be used by Piper Cobey Copier Service. Your information will not ever be sold, traded or given to any other business or person. This questionnaire is only the first step in the process. After you have submitted your information I will give you a call to set up an in person meeting to discuss your office equipment needs.

Account information

Username: *

Your preferred username; punctuation is not allowed except for periods, hyphens, and underscores.

E-mail address: *

A valid e-mail address. All e-mails from the system will be sent to this address. The e-mail address is not made public and will only be used if you wish to receive a new password or wish to receive certain news or notifications by e-mail.

a. General

Business Name:

Contact First Name: *

Contact Last Name:

Address:

Business Phone: *

Mobile Phone:

Current Copier:

What is the brand and model of the copier you are currently using?

Current Copy Volume:

What is your current yearly copy volume?

b. Request

Equipment Status:

Are you interested in new or reconditioned equipment?

New Brand/Model:

If you selected "Brand New", which model are you interested in?

Reconditioned Equipment Type:

What type of reconditioned office equipment are you interested in?

Reconditioned Brand Choice:

What brand of reconditioned office equipment are you interested in?

Other Brand:

If you selected other brand, what brand are you looking for?

Specific Reconditioned Model:

If you are interested in a specific reconditioned model imput it here

Time Line:

In what time frame do you need equipment?

Budget:

What is your budget for this piece office equipment?

Leasing:

Are you interested in leasing the copier?

Serviced:

Are you interested in having a service contract for the copier?