Name:       
  E-Mail:   


  Company:    
  Title:    
  Address:  
            
  City:      St: 
  Zip:       


  Phone:      
  Fax:      


Fold Format: 
		 
		C Fold 
	   	V Fold     

Qty 1   Qty 2   Qty 3 

Paper Size:   
	 
	Laser - Letter (8 1/2" X 11") 
	Laser - Legal (8 1/2" X 14") 
	Continuous - Letter (9 1/2" X 11") 
	Continous - Legal (9 1/2" X 14")  
          
Approximate Monthly Usage:  

Printer Make & Model: 
   
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