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Network Site Survey
Product Information Request
Supply Order Form
Service Request
Supply Request
Meter Reading
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Credit Application
How Are We Doing?
* Indicates Required Fields
Date
Equipment Being Proposed
EOS Systems Consultant
* Customer First Name
* Customer Last Name
* Company Name
* Email
* Telephone
Fax
Address
City
State
Zip
Website Address
Key Contact Names
Operator
Email
Telephone
Ext.
Manager
Email
Telephone
Ext.
MIS Director
Email
Telephone
Ext.
Outside Consultant
Email
Telephone
Extension
A) Are you operating a network at this time?
Yes
No
Peer to Peer ?
Yes
No
B) Do you print multipart forms?
Yes
No
C) Do you print to color inkjet printers ?
Yes
No
If yes, what is the estimated monthly output volume?
D) Is a network drop available?
Yes
No
If no, please provide a date when it will be available.
E) Do you use PostScript printer language?
Yes
No
Level
F) Media Type :
10 Base T
100 Base T
Token Ring
Paralell
Server Information
G) Windows:
Server O/S version #
Server Name
Workgroup / Domain
Please provide TCP/IP # for printing
Please provide TCP/IP # for scanning
Subnet
Gateway
H) Novell:
Server O/S version #
File Server Name
Net #
Print Server Name
Print Queue Name
List NDS Tree
I) A/S 400:
Do you print using NDPS?
Yes
No
Interface Type
Twin Ax
Ethernet
Is IPDS printing needed?
Yes
No
Workstation Information
J) What Workstation Operating System and how
many
of each? What version?
# of
Windows 95/98
v
# of
Unix
v
# of
Windows NT
v
# of
Linux
v
# of
Windows 2000
v
# of
Mac
v
# of
Windows XP
v
# of
Other:
v
K) Number of total users on the network:
Software Application Information
L) Software Applications Used. Please provide electronic copies of print file samples for pre-installation testing.
Quark Xpress
v
MS Word
v
Photoshop
v
MS Powerpoint
v
Illustrator
v
MS Works
v
Corel Draw
v
Word Perfect
v
Pagemaker
v
AutoCAD
v
Lotus
v
Other:
v
Scanning Information
M) Primary DNS
Secondary DNS
N) POP3
SMTP
O) Delivery Server IP Address
Customer Signature
Cust Net Admin Signature
Sales Rep. Signature
Please include any questions or comments in the space provided below.
The IP address
38.103.63.61
is a legally binding signature recognized by the "Electronic Records and Signatures in Global and National Commerce Act" (E-SIGN) (Pub.L. 106-229, 1, June 30, 2000, 114 Stat. 464, codified at 15 U.S.C. 7001 -- 7006)
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© 2005 Electronic Office Systems