Service and Supply Request Form Company Name Contact Name Phone NumberEmail Do you currently have a maintenance agreement with us? Yes No I need one Please select the brand of your machine: Copystar Kyocera Sharp Toshiba Other If "other" please specify What is the model number of your machine?(model number can be found typically on the front of the machine) Are you looking for supplies (i.e. toner) or service? Supplies Service Both What is the issue with the machine?Please be as detailed as possible if there is a code being displayed please include the code in your answer. What supplies do you need?If you need toner the machine will indicate the color with an initial at the top of the screen ( i.e. Y | M | C | B ) Please include the appropriate letter(s) in your answer. If you need toner are you completely out currently? Yes No Not sure Anything else you'd like us to know?PhoneThis field is for validation purposes and should be left unchanged.