Copier Order Form

Department:
Street Address/Room #:
Contact Person:
Phone:	Fax:
Email:
Budget #(s):	/ %
	/ %
Budgetary Head Approval:
Are you replacing a copier?	Yes No
Must stairs be used?	Yes No
Model To Be Replaced:
Serial Number:

Requested Configuration: (for pricing information, click here.)
Bizhub 160 - 16 ppm. Features: Enlarges, reduces, 25-400% zoom range,250 sheet paper drawer, 10 sheet bypass
Bizhub 200 - 20 ppm. Features: enlarges, reduces, automatic document feeder, automatic duplexing, two 500 sheet paper drawers, Optional finishing, add $20.00/month for Bizhub 200F
Bizhub 250 - 25ppm. Features: Enlarges, reduces, automatic document feeder, automatic duplexing, two 500 sheet paper drawers, Optional finishing, add $20.00/month for Bizhub 250F
Bizhub 421 - 42 ppm. Features: Enlarges, reduces, automatic document feeder, automatic duplexing, finisher with stapling and sorting 3,250 sheet paper capacity, including 150 sheet intelligent bypass
Bizhub 600 - 60 ppm. Features: Enlarges, reduces, automatic document feeder, automatic duplexing, stapling, sorting finisher 3,600 sheet paper capacity.
Bizhub 750 - 72 ppm. Features: Enlarges, reduces, automatic document feeder, automatic duplexing, stapling, sorting finisher 3,600 sheet paper capacity
Bizhub 1050 - 105 ppm. Electronic Document Handler, duplexing, 3,000 sheet universal paper supply
Bizhub C250P - Full Color Printer with Emperon embedded print controller
Bizhub C253 - Full Color Printer/Copier/Scanner with Emperon embedded print controller for scanning, and printing, automatic document feeder, automatic duplexing, two paper drawers, 100 sheet bypass
Bizhub C353 - Full Color Printer/Copier/Scanner with Emperon embedded print controller for scanning and printing, automatic document feeder, automatic duplexing two paper drawers, 150 sheet bypass
Bizhub C451 - Full Color Printer/Copier/Scanner with Emperon embedded print controller for scanning and printing, automatic document feeder, automatic duplexing two paper drawers, 150 sheet bypass

Do you require any accessories which are not included in the base price of your model?

Yes No

Describe:

Please complete all sections. Telephone Ellen Flak, x17419, with questions. After you submit the form online, you will be contacted to confirm your order. Allow 10 business days for delivery.