Site Assessment
Business
Business Name
Main Contact name
Business Email
example@example.com
Business Phone
Please enter a valid phone number.
Address of Delivery
*
Delivery Address
Street Address Line 2
City
State
Zip Code
Hours of Operation
Unavailable Delivery Days
Who should we schedule delivery with?
Please Select
Main Contact
Alternate Contact
Other (I am explaining in notes section below)
Who will let us in the building?
Please Select
Main Contact
Alternate Contact
Other (I am explaining in notes section below)
Alternate Contact Name
Phone Number
Please enter a valid phone number.
Alternate Contact Email
Environment
Elevator Access
Yes
No
Loading Dock
Yes
No
Construction Site
Yes
No
Number of steps our techs will have to go up with the device(s)
0
1-5
5+
Parking and Environment information
Please include any notes regarding the parking or environment such as street parking, gated entry, narrow hallways, or indoor carpeting
Power and Network
MANDATORY BEFORE DELIVERY CAN BE SCHEDULED
Your Current Power Outlet(s) (choose all that apply)
Is there an available network (ethernet) port where the new copier will be going?
Please Select
Use the ethernet port already in use with the current copier/equipment being replaced
There is an open ethernet port nearby that the new copier can connect to
There is not an ethernet port nearby - printer must connect wirelessly to network
I do not know
This question relates to how your copier is connected to the network. It does not change whether or not your computers will be able to print to it.
How many power outlets are available?
How many network ports are available?
Device
Operating systems used to print (Select all that apply)
PC
MAC
Chromebook
Phone/Tablet
Number of devices that will be used to print
Is there security software on the computer(s) that may block the download of drivers?
Yes
No
Are any of these needed on your new device(s)? (check all that apply)
*
Scan to folder
Scan to email
Faxing
User Authentication/Department IDs
None of the Above
Are we removing your old device(s)?
Yes
No
How many devices are we removing?
Does your company use a print server?
Yes
No
I don't know
Does your organization have IT?
Yes
No
IT
IT Contact Name:
IT Provider is:
IT Contact Email:
IT Contact Phone Number
Please enter a valid phone number.
IT is:
Onsite
Offsite
3rd Party
Will IT be available during Installation?
Yes - They are freely available
Yes - But only by appointment
No - They are not available to help
No - They will no longer be in contract
Are you able to answer questions related to the network and scanning functions of the copier?
*
Yes
No
Networking
Are we reusing your IP address?
Yes
No
Please list the desired IP address(s) and locations for the new device(s) below. Click "Save Entry" for each row:
Subnet
Gateway
DNS 1
DNS 2
Device Address Book
Select One
I will attach an Excel file of names and email addresses with this form.
I am including the names and emails of the people I want to add to the address book in the section below.
I wish to add the address book myself after installation.
Upload your address book here (excel file, text file, or word document):
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Please list the names and emails for the users you want added to the address book here. Click "Save Entry" for each row:
Scan to Email
SMTP Server Address
SMTP "From" Address
Port Number
25
465
587
Other
Port Type
SSL
TLS
SSL/TLS
SSL Off
Authentication
Notes
Enter any additional notes or comments here:
DO NOT TOUCH
Submit
Should be Empty: