Customer Site Survey

Customer Site Survey
Account Name
Customer Contact
Phone Number
Address/Location of Equipment
(Department, floor, etc.)
Model
Serial
Sales Rep Name (Print)
Phone Number
Please enter a valid phone number.
Number of Clients
Are there stairs

Stairs
IP Address
Subnet Mask
Gateway
Domain
DNS1
DNS2
Section III LAN Physical Wiring/Cabling

Choose one of the following three ways to connect the copier/printer.
What type of connection are they using (Physical is standard)

USBWireless; Built in or Range ExtenderPhysical
Software
Software
Software
Please list all features to be installed or enabled in addition to standard print connectivity:
Scan to Folder Details
Scan to Email Details
Network Fax Details
Fax Forwarding Details
User Code Details:
Section VI Additional Information
What Type of Outlet is Currently There*

120V 15A NEMA 5-15R120V 20A NEMA 5-20R120V 20A NEMA 6-20R
Type a question

Windows ServerWindows 10/11Mac OSOther
Meter Reading Method

EmailFM AuditAutomatic Email From Device
SMTP Server
SMTP Port
SMTP Username
SMTP Password
Wreless SSID
Wireless Key
Section VII Electrical Requirements
CAR Tech (Print)
Customer Signature

Clear
Date

MonthDayYear
Date
Digital Sales Specialist
Comments
Should be Empty: