First
Name/M.I.
*
Last
Name
*
Title
Job Function
Choose one
Engineering
Finance
Human Resources
Internet Support
Marketing
Operations
Purchasing
Sales
Technical Support
Other
Company
*
Industry
Choose one
Aerospace
Commercial
Computer Hardware
Computer Software
Construction
Consulting
Copy Shop/Service Bureau
Education, Higher
Education, K-12
Engineering
Finance/Securities
Government, Federal
Government, State
Health/Medical
Insurance
Manufacturing
Not for Profit
Pharmaceuticals
Publishing
Real Estate
Retail
Service
Software/Web Development
Transportation
Utilities
Other
Address
1
*
Address 2
City
*
State
*
Zip
*
Phone
Number
*
Fax
Which
Inklusive program are you interested in?
E-mail
*
May we contact you to send coupons, rebates and inform you
of other programs and promotions on Media Sciences products?
Yes
No
Do you currently own a color printer?
Yes
No
Who is the manufacturer?
Choose one
Brother
Canon
Dell
Epson
Hewlett Packard
Lexmark
Minolta
Mita
QMS
Ricoh
Tally
Tektronix
Xerox
What is the model?
What type of printer?
Choose one
Liquid ink jet
Bubble jet
Solid ink
Color laser
Dye sublimation
Thermal wax
How many color printers are in your organization?
Choose one
1
2
3
4
5
6-10
11-15
16-25
26-40
40+
How many color prints do you do a month?
How did you hear about INKlusive?
Questions and Comments