Company:Telephone:
Address:City, Zip
Dealer Region: 

 Account Executive:
 Equipment to be installed:


   Network Staffing:
Administrator:Telephone:
Do you have  IT Staff Onsite IT Staff Offsite 


   Network Security:
  Do users have administrator rights on their local machines? Yes   No
  Are there network permissions that restrict file & printer sharing? Yes   No
  Do you have a firewall the prohibits anonymous SMTP access? Yes   No
  Do users have a personal firewall on their local machines? Yes   No
  Are there file size restrictions on your mail server? Yes   No


   Operating Systems (Total users for each on your network)
 Windows XP Mac OS X Unix
 Windows 2000 Mac OS 9 AS-400
 Windows NT 4.0/3.51 Mac OS 8 Citrix
 Windows ME/95/98 DOS Other


   Applications other then standard Windows based  (Please fill in the appropriate boxes)
 PC: Other Applications  Mac: Other Applications


   Network Servers (Please fill in with type)
 Type of Server


   Network Information (Please fill in any appropriate box)
 IP Addresses are :
  Assigned by DHCP Static Addresses Wins Resolution Other
  Workgroup   Domain Name 
   Misc  


   MFP Network Information
 Note: MFP is HIGHLY recommended to use a static IP address.
 Proposed IP Address of MFP:
 Subnet Mask
 Gateway
 SMTP Server Address:
 SMB Device Name:
 Printing via:   Server Share  OR  Local Install   X  Workstations
 Scanning to:   File:  E-Mail:  Desktop:  FTP:
 Note: Customer is responsible for cabling to the MFP


Note: The installing dealer can install network cables, network cards into client PCs, network protocols or perform general network troubleshooting in areas not pertaining to installation of the MFP for an additional fee.