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Company Information:
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*State: *Zip:
*Phone: Fax: *Email:

Imaging Device Information:

Copies Per Month: Prints Per Month:  
Fax Option?....................... Yes No Print Option?........ Yes No  
Scanning Option?............ Yes No Network Option? Yes No  


Mailing Device Information:
Current Postage Method: Current Brand:
Average Monthly Postage Cost: Current Model:

Rates Used (Please Check All That Apply):

First Class

Presort Periodicals Non-Profit      
Bulk Mail International UPS FedEx      


A better understanding of who our customers are helps us to offer you more individualized product
solutions and services. Please take a moment to answer the following questions about your business.
Business Type (i.e marketing, advertising, electrical,accounting, etc.)
Product Line or Industry:
Geographic Coverage: Business Style:
Group or Organization Affiliations? (Please list all below)
Number of Employees: Number of Locations:
Annual Sales?    
Who makes the purchasing decisions for your company?
Their Name:
Their Title:
Their Department:
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920 E. 21st Street, Des Moines, IA 50317
800-532-1565 Toll Free
515-262-2100 Des Moines IA
Des Moines   •   Coralville   •   Dubuque

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