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User Information
* indicates required field
Address Type
Address Type
Home
Business
School
Government
Name
*
First name
Last name
Title
Title
Company Name
Company name
Address
*
Address
Apartment #
Apartment #
Address
City
City
State
*
State
Select State
Alabama
Alaska
Arizona
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Bermuda
California
Colorado
Connecticut
District of Columbia
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Florida
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Maryland
Massachusetts
Michigan
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Ohio
Oklahoma
Oregon
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South Dakota
Tennessee
Texas
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Vermont
Virginia
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West Virginia
Wisconsin
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Zip
*
(Example: 00000)
Zip
Phone No
Phone No
Fax. No.
Fax. No.
E-mail address
E-mail address
Product Information
* indicates required field
Date of purchase
*
Date of purchase
Model
*
Model Name
Select model
Aficio GX e3300N
Aficio GX e3350N
Aficio GX e5550N
Aficio GX3000sf
Aficio SP 1210N
Aficio SP 3400N
Aficio SP 3410DN
Aficio SP 4100NL
Aficio SP 4110N-KP
Aficio SP 4310N
Aficio SP 5100N
Aficio SP 5200DN
Aficio SP 5200S
Aficio SP 5210DN
Aficio SP 5210SF
Aficio SP 5210SR
Aficio SP 6330N
Aficio SP 8200DN
Aficio SP 9100DN
Aficio SP C232DN
Aficio SP C242DN
Aficio SP C320DN
Aficio SP C430DN
Aficio SP C431DN
Aficio SP C431DN-HS
Aficio SP C820DN
Aficio SP C820DNLC
Aficio SP C820DNT1
Aficio SP C820DNT2
Aficio SP C821DN
Aficio SP C821DNLC
Aficio SP C821DNT1
Aficio SP C821DNX
Ricoh GX3000s
Ricoh GX7000
Product serial number
*
Product serial number
Purchased from
*
Purchased from
Certificate #
Certificate #
How did you hear about this product?
In Store
Trade Show
Direct Mail
Magazine
Friend/Aquaintance
Sales Representative
Web or E-mail Communication
Newspaper
Catalogue
Others
What were the TOP THREE reason for choosing this product?
Image Quality
Features
Space Saving
Salesperson Recommendation
Styling/Appearance
Other Recommendation
Price/Value
Overall Product Quality/reliability
Magazine Advertisement
Overall Cost of Ownership
What were the main applications used for the product? (Check THREE only)
Adobe Acrobat
Intuit QuickBooks/Quicken
Adobe PhotoShop/Elements
Macromedia Flash/Dreamweaver/Fireworks/Contribute
Adobe Indesign
Microsoft Access
Adobe Illustrator
Microsoft Excel
Apple Aperture
Microsoft PowerPoint
Apple iPhoto/Life
Microsoft Project
Apple iWork/Keynote/Pages
Microsoft Publisher
AutoDesk AutoCAD
Microsoft Visio
Corel Draw
Microsoft Word
Corel PaintShop/Painter/PhotoAlbum
Sage Act
Corel WordPerfect
Web Browser
Email Application
Other
FilemakerPro
What percentage of your documents use color?
Less than 25%
25% - 49%
50% - 74%
75% - 100%
Is the product connected to a network?
Yes
No
If Yes:
Connected Through
Element
WiFi
External Ethernet Printserver Appliance
External WiFi Printserver Appliance
Peer to Peer
PC Print Server
One to One
Other
Server operating system is
Windows Vista
Windows 2000
Windows XP
Windows 95/98/ME
Windows NT
Netware 6.xx
MS-DOSe
Netware 4.xx
Netware 5.xx
Macintosh OSX
Macintosh OS9
Other
Windows 2003
How many people share this product?
1 - 10
11 - 30
31+
Products
Multifunction
Production Printing
Printers
Facsimile
Digital Duplicators
Wide Format
Parts and Supplies
Projectors
Network Accessories
Continuous Forms Printers
Services and Solutions
Capture & Distribution
Storage & Management
Output & Security
On-Demand Web Services
Camera Imaging
Hardware Enablers
MFP Keyboard
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