FicheNet Imaging Solutions 110 West C Street Suite 2019 San Diego, CA 92101-3998 Ph: 619.326.0644 Fax 619.326.0647

Questionnaire For a Microfilm Page Printing Quote - BETA

On-Line Form

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

Name of My Application or Job:

_________________________________

Microfilm Page Printing

I have the following type of microfilm that needs Printed:
	16mm Roll Microfilm
	16mm Jackets
	35mm Roll Microfilm
	35mm Jackets
	35mm Aperture Cards
	105mm COM Microfiche
	105mm True Microfiche
Do you know if your film is a master or a duplicate?
	Master	Will provide better quality prints
	Duplicate	Can provide quality prints, but more often than not they won't
Is your film Positive or Negative:
	Positive	has dark writing on clear background
	Negative	has clear writing on a blue or black background
What size of prints would you like:
	8.5 x 11
	11 x 17
How many sets of prints do you need?
	____________________
Approximately many images do you need printed (in one set)
	____________________

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:
	_________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________

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

Any Other Details Below:

Any Other Details Below:   _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________