Machine order

Sales Rep*

Sales Rep Email*

Used for confirmation email

Company Name*

Install Address*

Street Address

Street Address Line 2

CityState

Zip Code

Is the Billing Address the same as the Install Address?

Additional Bill To or location information:

Contract Contact Name*

First NameLast Name

Contract Contact Phone Number*

Area CodePhone Number

Contract Contact Email*

example@example.com

Equipment Contact Name

First NameLast Name

Equipment Contact Phone Number

Area CodePhone Number

Equipment Contact Email

example@example.com

Type of agreement*

Vaulequix order numbers for tracking in DOS prompt

Machine Model being installed*

Any special info like apps defaults etc.*

What does the customer want*

Base install Hours

Do we need to do training?*

Is there a trade?*

If yes, what is the model and serial number.

Delivery type*

Stairs or Elevators*

How many Stairs

Loading Dock*

SME Yes/No*

If yes, what is the SME number

Is machine new or used*

If used, what is the SN#

If used, what is the start meter

Source of machine*

Machine needs to be ordered through our vendorsMachine was ordered through valueQuixMachine is at the office no need to order

Does XDA need to be installed*

Is the customer already a XPPS customer?*

YesNo

How is it being billed*

Who is billing for the equipment*

Other Billing Information

Base charge for XPPS*

Cost per page B&W*

Cost per page color*

Cost per page escalation after year 1*

Notes

Any other info to relay to office personnel

New Order

Billing Info