IT SURVEY FORM
Don't Forget to click "Submit" at bottom of page!
Contact Information:
*
Customer Name
*
IT/Copier Contact Person
*
Email Address
*
Phone
Equipment Information:
*
Name/Model of Equipment to be Installed
*
Primary Uses of Equipment
Check all that Apply
Copy
Print
Scan
Fax
Other
*
Is Power Adequate?
Proper plugs, Voltage, Safety
Yes
No
Please Check for Me
Any Special Software in Use?
N/A
Yes (Please describe in comments)
No
*
Handicap Access to Equpment?
Yes (have elevator, ramps, etc...)
No (stairs, etc...)
Does customer need IT to discuss any further Solutions?
N/A
YES
NO
Additional Comments
Network Information:
Type of Network Environment:
MAC
WINDOWS PC
OTHER
MAC AND PC
How Many Computers?
1-5
5-10
10 or more
Does Modern Impressions need to provide any equipment or cables?
YES
NO
Not Sure
Is network connection/outlet available at equipment?
N/A
YES
NO
Install Print Drivers
On Each Computer
Shared from Server
What Type of Connection?
USB
PARALLEL
NETWORK
Detailed Network Information:
IP Address for Equipment
Subnet Mask
Gateway Address
DNS Server (s)
Fax Phone Number
Additional Info
*
Required Fields
