CBS

CBS Site Survey

Please complete the fields listed below & select the Print Page option (for your records) before submitting the form.

Customer Information

Customer Name

Street Address   Floor/Room

City   State Zip

Email

Purchasing Contact Phone (with area code)    Ext

IT Contact Phone (with area code)    Ext

Sales Rep Ext

Delivery Date Pickup Date

Hours of Operation

Field Demo In-house Demo Trial Sale Other

Demo Date Demo Time

Machine Requested (model #)

Accessories

Delivery Site Survey

Any outside steps?
If yes, how many?

Yes

No

Steps

Any inside steps?
If yes, how many?

Truck docks?

Are all doors wide enough?

Are all elevators wide enough?

Are all hallways wide enough?

Is there enough space where the copier will be placed?

Is there dedicated power for the copier?

CSR training?

Network Site Survey

Desktop Operating System:

Network Operating System:
Static IP Address for Equipment:

Subnet:

Gateway:

DNS:

DNS2:

SMTP Server Address:

Maximum Email Attachment Size:

Domain Name:

LDAP: context name (example dc=domain, dc=com)

Is there a network drop(s) at the equipment location? Yes No

Do you have a patch cable to connect to the equipment? Yes No

Do you want to scan to file? Yes No

Do you want to scan to email? Yes No

Do you want desktop faxing? Yes No

Do you need wireless capabilities for your network? Yes No

Please list any special applications or circumstances that may require additional consideration:

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