Welcome to Visual Media Services

COPIER APPROVAL FORM

Please provide the following information concerning your copier purchase requisition. This information This information is necessary to process your order.

REQUISITION INFORMATION
Name: (required)
email: (required)
Department:
Mail Station:
Phone: (required)

COPIER INFORMATION
Location of requested copier:
% of jobs requiring:
Collating
Duplex copying
Stapling
Reduction or Enlargement
Copying speed:	Copies/Min.

CURRENT VOLUME
Jobs per month:
Originals per job:
Copies per month

NEW MACHINE SPECIFICATIONS

NEW MACHINE COPY OPTIONS

Copying Speed:

Document Handler Yes No

Collating/Sorting Yes No

Stapling Yes No

Reduction or Enlargement Yes No

If Yes, % to %

1 sided to 1 sided Yes No

1 sided to 2 sided Yes No

2 sided to 2 sided Yes No

2 sided to 1 sided Yes No

NEW MACHINE SPECIFICATIONS

Make:

Model:

Number of copies included
(if applicable)

Averages @ $ /copy

Manufacturer's recommended
monthly volume /month

Is this a replacement for
the current copier? Yes No

ESTIMATED COST/MONTH

total cost/month $

HOW OBTAINED

Lease: LTOP: Purchase:

EXISTING MACHINE SPECIFICATION

COPY OPTIONS

Copying Speed:

Document Handler Yes No

Collating/Sorting Yes No

Stapling Yes No

Reduction or Enlargement Yes No

If Yes, % to %

1 sided to 1 sided Yes No

1 sided to 2 sided Yes No

2 sided to 2 sided Yes No

2 sided to 1 sided Yes No

EXISTING MACHINE INFORMATION

Make:

Model:

Estimated downtime: hr/month

Date acquired:

Copier disposition

Excess

Traded In

Returned to Vendor

Other:

ESTIMATED COST/MONTH

total cost/month $

HOW OBTAINED

Lease: LTOP: Purchase:

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