Southern California
Copier Rental Request Form
Fields marked with an asterisk (*) are required
General Information:
First Name:*
Last Name:
Company:
Your e-mail address:*
Please enter your e-mail address again:*
Phone number 1: (with area code)
Phone number 2: (with area code)
Please tell us how you found us:
Please select one
Google
LA CVB web site
LBA CVB
Yahoo!
Nine MSN
AltaVista
Yellow Pages
Word of mouth/referral
I've used your service before
Other
Product Needs:
Type of machine that you need:
Please select one
B/W Digital Copier
Color Copier
Fax Machine
High Speed Printers
This rental is for:
Please select one
Entertainment Production
Short-term office need
Conference
Other
B/W Digital Copier:
Please select one
Konica Minolta Bizhub 920
Konica 7085
Konica 7075
Konica Minolta Bizhub 7272
Konica 7165
Konica 7065
Konica 7155
Konica 7055
Sharp AR M205
Sharp AR 168
Color Copier:
Select
Konica 8050
Ricoh 6513
Fax Machine:
Select
Sharp FO4450
Notes and comments: