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Company Name:  *
Address: 
City: 
State: 
Zip: 
Phone:  *
Fax: 
Email:  *
Type of Business: 
Name of individuals involved with decision-making process:
 
  Name Direct # or Extension
Administrative Manager
MIS/Telecom Manager
Executive
Fax Operator

Current Situation
Own   Lease   Rent Expiration Date:
Do you have a fax machine under a maintenance agreement? yes no
How many fax machines do you currently have?
Brand Model Departments Location % of Use Pages
Do you wish to monitor or restrict fax usage? yes no
Do you have peak fax periods? yes no
Describe:
How many employees in your company operate the facsimile equipment?
What would be the maximum number of pages sent at one time?
How often? %
How many pages TRANSMITTED per day/week?
How many pages RECEIVED per day/week?
X = ÷ = %
Total Pages
Per Week
(% of busy
signals)		 Avg. Seconds
Per Page
(Avg. business
is 50 seconds)
 Total On Line
Seconds
Per Week
Total Seconds
Per Week
(ex: 144,000
Per 40 Hours
8 Hours/Day)
 Collision Factor
Average % of
busy signals
What percentage of received fax pages are copied? %
Do you need to make multiple copies of received pages? yes no
How many?
Do you ever send the same documents to more than one location? yes no
How often?
Do locations change on a regular basis? yes no
How many locations?
Average number of pages?
How many photos/graphics do you need to send per week?
What percentage of your facsimile transmissions are local/long distance?
%(within local area code 612) %(domestic long distance) %(international)
What percentage of your incoming documents need to be received on different paper sizes?
Letter % Legal % Other %
What size documents do you need transmitted?
  Letter   Legal   11 x 17   Other
Do you save your activity reports? yes no
Do you need to receive confidential information? yes no
What type of phone system do you have? PBX   Key Type
Brand: Model:
# of CO Lines:   # of Lines/DIDs:   # of Analog Extensions:
Dedicated Fax Line: yes no ISDN   Switch 56
 
What type of computer system do you have?
Main Frame PC MAC LAN Type:
What is your proposed time frame?
Budget?
What features are you looking for in a facsimile system?
* indicates required fields
 
Have a question? Call (952) 925-6800 and speak to a Loffler representative now.




Loffler Companies, Inc.
1101 East 78th Street
Suite 200
Bloomington, MN 55420

952.925.6800
FOR IMMEDIATE SUPPORT

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