Questionnaire For a Microfilm Duplication Quote - BETA

Printable Form

My Contact Information:
	Name
	Company
	Title
	My companies web http://
I Prefer to be Contacted By:
	Phone		Ext
	e-mail

Index of the Questionnaire
Media Duplicates
Delivery or Shipping
Payment Method
Any other details

Name of My Application or Job:

Media Duplication

We can make multiple sets of any of the below media.
I have the following media:
	16mm Roll Film
	35mm Jackets
	16mm Jacket
	105mm COM Fiche
	105mm True Microfiche
	We are no longer offering any 35mm aperture card or 35mm roll film duplication services.
Is your media a master or already a duplicate? (making duplicates of duplicates can be performed, but it creates some issues that we will need to discuss.)
	Master
	Duplicate
How many rolls / fiche do you have?
How many duplicate of each do you need?

16mm Roll Film Returned in: (all with laser printed labels)
	3M Cartridges
	ANSI C-Clip
	Square/Round White Reel in Plastic Film Box
	Square/Square Black Reel in Plastic Film Box

105mm Microfiche, 16mm & 35mm Jackets Can have a Colored Stripe:
	White		Red		Light Blue
	Yellow		Light Green		Lavender
	Pink		Dark Green		Gray
	Purple		Orange
	Some colors are in limited supply and availability may change without notice as we are phasing out the old colors. White will always be available.

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Delivery or Shipping:
	FicheNet Imaging Solutions Pick Up and Deliver
	Use my own Company Courier
	Ship with Fed Ex
	Ship with UPS
	Ship with USPS
	Overnight? Second Day? Special Hours? Other:

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I Wish to Pay by: (all Invoices are Due Upon Receipt Unless otherwise arranged)
	Purchase Order / Company Check
	PayPal
	Personal Check
	Cash
	Other:

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Any Other Details Below:

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