Questionnaire For a Microfilming Quote - BETA

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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 Type(s)
Number of Documents
Document Size
Document Condition
Staples
Colored Documents
Document Preparation
Media Duplicates
Indexing
Delivery or Shipping
Payment Method
Destroy or Return Documents
Any other details

Name of My Application or Job:

I am interested in this media(s) (select all that apply)
Filming:
	16mm Roll Film
	105mm Microfiche
	We are no longer offering any 35mm Roll Film, Jackets or Aperture Card filming services.

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Number of Documents Approximately:
	Documents
	File Boxes
	File Drawers (standard)
	File Drawers (Deep Cabinet)
	Lateral File Drawers
	Other Explain

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My Documents are this size:
	Mostly 8.5" x 11" or less
	Mostly 8.5" x 14"
	Mostly Greater than 8.5" x 14", but less than 11" x 17"
	Oversized - Greater than 11" x 17"
	Bound Books
	If Bound Books Please Explain:
	Type of Book
	Can they be unbound?	YES - NO
	If the media allows for it would you like two pages per image?	YES - NO
	If you have a mix of the above can you give more details below:

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My Documents are in the following Condition
	Excellent (no folded corners, no tears, no sticky notes)
	Good (a few folded corners, a few torn pages...)
	Fair (some folded corners, some torn pages...)
	Poor (many folds, tears and rips)
	Very Poor (looks like your dog had it for lunch)
	Comments:
	Oversized drawings (11" x 17"+) they are:
	Rolled Folded Flat or Hanging Other

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Do Your Documents Have Staples?
	YES		NO
		1 every 2 or 3 pages
		1 every 5 to 10 pages
		1 every 10 to 20 pages
		1 every 20 to 50 pages
		1 every 50 to 100 pages
		Less than 1 per 100 pages

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Do You Documents Have Any Colored Elements? (Most colored elements will drop out during filming however certain darker colored paper such as red and some others will not film correctly)
	YES	NO
	Please Explain:

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Will You Prepare or Consider Preparing the Material for Filming/Scanning ti Ensure it is Arranged in Proper Order and Indicate any Missing Pages or Item?
	YES	NO
	Please Explain:

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Media Duplication

FicheNet Imaging Solutions clients customarily choose to purchase at the minimum 2 generations of microfilm or electronic media. The first generation is the Master. This Master serves as the archival media and should be kept in an environmentally controlled storage facility. The second generation, or Duplicate, is the working copy of the Master. This is the media that should be used on a day to day basis for retrieving and viewing
Would You Like Duplicates of Your Media?
	YES	NO
	If so how many:

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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Indexing for Microfilm:
	Approximately how many documents per file or how how many pages per reference point?
	There are two types of Microfilm Indexing:
	Level I
		Indexing using a From -Thru System. This method is performed either by putting a "FROM: file name - THRU: file name" directly on the title of the 105mm Microfiche or 16mm/35mm Jacket AND/OR by using "FROM: file name - THRU: file name" on the 16mm or 35mm film box labels. See HERE for examples. .
	Level II
		Comprehensive Indexing from the film. This method of indexing uses a numeric numbering system for 16mm roll film and an alpha numeric grid system on the 105mm microfiche to reference your files. In addition to roll & frame or fiche & frame we can index 4 or 5 or more other fields to cross reference to. See HERE for examples.
	Keep in mind that Level I is limited by the spatial limitations of the film box and the fiche title areas and that Level II is virtually unlimited.
	Please list the specific fields for a Level II index and approx. character length of each field below
	(i.e. Data Field#1=SSN# is 11 characters)
	Level II Index Returned how
		Paper - 3.5" Diskette - CD-R - e-mail
		Windows Format:
	Special Instructions for Data:
	Will you require any viewing equipment: YES NO
	Will you require any viewing/printing equipment: YES NO

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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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Post Conversion Document Destruction or Return:
	After the conversion project is completed do you wish to have your documents Returned or Destroyed. Destruction takes place a min of 90 days after your project is completed and there is an authorization form that must be approved before we complete the destruction for more information about Destruction look <HERE>
	Return Documents
	Hold for Destruction
	Notes:

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Any Other Details Below:

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