<p> Ricoh Printing Solutions Division Authorized Service Provider Application </p><p>Date: Ricoh Partner ID (if applicable): Company: DBA (if applicable): Number of locations: (If more than one (1), please fill out the Additional Location Section) Address: City: State: ZIP Code: Country: Phone: Fax: Website: E-mail: Years in Business: Federal Tax ID#: </p><p>Billing Address: Same as main company address (if not, please fill out below) Address: City: State: ZIP Code: Country: Phone: Fax: </p><p>Primary Contact: Name: Position / Title: Same as main company address (if not, please fill out below) Address: City: State: ZIP Code: Country: Phone: Fax: </p><p>What are your company’s approximate total annual sales? Less than $100,000 Between $3 million and $5 million Between $100,000 and $500,000 Between $5 million and $10 million Between $500,000 and $1 million More than $10 million Between $1 million and $3 million</p><p>Authorized Service Provider Application 1 Submit via email to [email protected] Confidential Submit via fax to (678) 597-3506 Ricoh Printing Solutions Division Authorized Service Provider Application Questions: 1) Are you (check one): Regional Reseller National Reseller Self Service Provider Name of Company: Designated Service Org. Name of Account: </p><p>2) Please indicate the number of technical people that are directly employed b your company. Service Management Service Technicians Microsoft/Novell Certified Technicians Other Certified Technicians Certification(s): </p><p>3) How many of your service technicians do you plan to train on Ricoh printers / scanners?</p><p>4) What laser printers or scanners do you currently service? Service Authorized by Manufacturer Product Line(s) Manufacturer? Yes No</p><p>5) What other products do you currently service? Service Authorized by Manufacturer Product Line(s) Manufacturer? Yes No</p><p>Authorized Service Provider Application 2 Submit via email to [email protected] Confidential Submit via fax to (678) 597-3506 Ricoh Printing Solutions Division Authorized Service Provider Application 6) What is your response time target for the products listed in questions 4 and 5? Hours</p><p>7) Have you had experience servicing color laser printers? YES NO</p><p>8) Describe your service escalation process.</p><p>9) Do you have a Customer Satisfaction Measurement System? YES NO If YES, please attach a description of your system or a copy of your survey form.</p><p>10) Describe the geographic area you will be servicing. Please be as specific as possible and attaché a list of ZIP codes serviced by your company if available.</p><p>11) Identify the Ricoh product(s) you wish to be authorized on.</p><p>THANK YOU FOR YOUR INTEREST IN RICOH PRODUCTS AND SERVICES!</p><p>Authorized Service Provider Application 3 Submit via email to [email protected] Confidential Submit via fax to (678) 597-3506 Ricoh Printing Solutions Division Authorized Service Provider Application Provide address for all service locations If you need more space for additional locations, please forward a list that includes the requested information to your Ricoh Channel Account Manager Address: City: State: ZIP Code: Country: Phone: Fax: </p><p>Address: City: State: ZIP Code: Country: Phone: Fax: </p><p>Address: City: State: ZIP Code: Country: Phone: Fax: </p><p>Address: City: State: ZIP Code: Country: Phone: Fax: </p><p>Address: City: State: ZIP Code: Country: Phone: Fax: </p><p>Address: City: State: ZIP Code: Country: Phone: Fax: </p><p>Authorized Service Provider Application 4 Submit via email to [email protected] Confidential Submit via fax to (678) 597-3506</p>