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

Printable Questionnaire For a Microfilm Processing 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

FicheNet Imaging Solutions uses only Kodak Chemistry for all film processing
I have the following type of microfilm that needs Processed:
	16mm Roll Microfilm
	35mm Roll Microfilm
	105mm Rolled Microfiche
Would you like duplicates?
	YES
	NO
	We no longer offer any 35mm roll film duplication services.
How many rolls of film do you have?
	____________________
How many duplicates or each do you need?
	____________________
Is this a one time project or a weekly or monthly job please explain:
	__________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________

16mm Master Roll Film Returned:
	Original Film Box
	Black Plastic Film Box

16mm Duplicated 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.

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:   _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________