New Order
Sales Rep
*
Michelle McManus
Brendan Lerman
Sales Rep Email
*
mmcmanus@benchmark-office.com
brendan.lerman@benchmark-office.com
Used for confirmation email
Company Name
*
Install Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Is the Billing Address the same as the Install Address?
Yes
No
Additional Bill To or location information:
Contract Contact Name
*
First Name
Last Name
Contract Contact Phone Number
*
-
Area Code
Phone Number
Contract Contact Email
*
example@example.com
Equipment Contact Name
First Name
Last Name
Equipment Contact Phone Number
-
Area Code
Phone Number
Equipment Contact Email
example@example.com
Type of agreement
*
XPPS
Agent
Dealer - No XPPS
Machine Conversion from Xerox to us
Vaulequix order numbers for tracking in DOS prompt
Machine Model being installed
*
Any special info like apps defaults etc.
*
What does the customer want
*
Print
Copy
Scan Email
Scan Network
Fax
PS
Base install Hours
Do we need to do training?
*
Yes
No
Is there a trade?
*
Yes
No
If yes, what is the model and serial number.
Delivery type
*
To BOS
To Customer
To FCL
Stairs or Elevators
*
Stairs
Elevators
None
How many Stairs
Loading Dock
*
Yes
No
N/A
Billing Info
SME Yes/No
*
Yes
No
If yes, what is the SME number
Is machine new or used
*
New
Used
If used, what is the SN#
If used, what is the start meter
Source of machine
*
Machine needs to be ordered through our vendors
Machine was ordered through valueQuix
Machine is at the office no need to order
Does XDA need to be installed
*
Yes
No
Already installed
Is the customer already a XPPS customer?
*
Yes
No
How is it being billed
*
Leased
Purchase
Rental
Who is billing for the equipment
*
BOS
Great American
Xerox Financial
Other
Other Billing Information
Base charge for XPPS
*
Cost per page B&W
*
Cost per page color
*
Cost per page escalation after year 1
*
0%
5%
10%
Notes
Any other info to relay to office personnel
Submit
Should be Empty: