QUALIFIED PRODUCT FORM

ENERGY STAR^® Product Information Form for Use by ENERGY STAR Labeled MFD Partners

(Companies who have joined ENERGY STAR for MFDs by signing the Memorandum of Understanding)

You may use this form to report only those products that are sold under your company’s brand name.  If your firm sells its models to another company that uses its own brand name, that company must join the program and report its own products.  Information from this form will be added to list of Energy Star qualified MFD products. Please copy this form and fax one for each qualifying product model to Energy Star, Environment and Development Foundation, 886-3-5820231.

Company Name:__________________________________

  (As listed in MOU)
Product Contact Information

(For public requesting product information)

Tel:________________  Fax:_____________________

E-mail: _______________________________________

Note: Please provide the following information on the configuration of the tested model ONLY.

*Single-sided originals to double-sided copies; based on 3 sets of 10 originals.

Please Describe the Type of MFD (check the appropriate boxes below):

^* Single-sided originals to double-sided copies; based on 3 sets of 10 originals.

Note applicable characteristics for tested configuration:

Tested By: (Name of Firm or Self-Tested)  __________________________________________________

Please provide the following information:

1. Does this MFD model have duplexing capabilities?

Yes _____   No _____   

2.a.  Is duplexing an optional accessory   

Yes _____   No _____

2.b.  Is the duplex unit set at “default-to-duplex” when shipped?

Yes _____   No _____

2. If this model is listed with the US General Services Administration, please include its schedule number and special item number

____________________________________________________

3. What minimum weight of paper (in grams/m2) do you recommend for the:

print engine? _______________________ document feeder?_____________________

Please list or describe any additional features below.

________________________________________________________