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Please just fill out the form below and someone will contact you as soon as possible. If you have additional machines, please submit additional forms.

Company
*First Name
*Last Name
Phone Number ()
*Email Address
Address

City
State
Postal Code
*Equipment ID located on front of machine (AIS Equp. ID)
*B/W Meter Please enter black and white meter reading
Color Meter Please enter color meter reading
Equipment Brand Lanier/Gestetner/Ricoh
Equipment Model ex. LD425
Consumable needed 1 Item needed
Qty 1
Consumable needed 2 Additional item needed
Qty 2
Consumable needed 3 Additional item needed
Qty 3
Consumable needed 4 Additional item needed
Qty 4
Consumable needed 5 Additional item needed
Qty 5
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