Officia Network Product Questionnaire
Company Name
*
Contact Name
First Name
Last Name
Contact E-mail
Contact Phone
-
Area Code
Phone Number
Network Admin
First Name
Last Name
Network Admin E-mail
Net Admin Phone
-
Area Code
Phone Number
Sales Rep
First Name
Last Name
Delivery Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Network
Wireless
100/1000 Base T
Direct (USB/Parallel)
Domain or Workgroup
*
Domain
Workgroup
Server Operating System
Mac OSX
Linux
Server 2008
Server 2012
Server 2016
Other
Client Operating System
Mac OSX
Linux
Windows XP
Windows 7
Windows 8/10
Which Option/Features will be installed?
Printing
Scan to Folder
Scan to Email
LanFax
User Codes
TWAIN
Mobile Print
Custom Drivers
Fax Forward
Data Port Available
Yes
Fax Port Available
Yes
Fax Header
Fax Number
Number of machines being installed
IP Address
IP Address 2
IP Address 3
Subnet Mask
Gateway
DNS 1
DNS 2
Scan2Folder Username
This is the username used for Scan to Folder authentication
Scan2Folder Password
This is the password used for Scan to Folder authentication
SMTP IP
SMTP Port
Standard ports are 25, 465 or 587
SMTP Username
SMTP Password
Administrator's Email Address
Will the Administrator's email be used as the default sender?
Yes
No
Power Outlets Available for new equipment
110V/15A
110V/20A
220V/20A
220V/30A
Network Services: As part of the networked device installation, Ricoh staff will perform tasks to verify proper connection and performance to product specifications.Standard installation includes:Physical network connection of the device and verification of connectivityInstall software drivers on 5 workstationsConfigure up to 5 Scan to Email, Scan to Folder and Fax DestinationsIMPORTANT: The Customer shall provide network cabling with proper connectors and an active network interface port. Additional services: Professional Services team can provide assistance to customize the network device to meet more specific needs. These services are outside the scope of the basic installation and are provided on a chargeable basis:Please note that install services that are declined during the initial installation visit can be performed at a subsequent visit on a chargeable basis.Network setup for additional users / workstationsNetworked server and network design implementationModifications to security, software or hardware firewalls or other network infrastructureTrain IT staff to administer and manage products on the networkCreate custom print drivers that enable/disable specific print features
Notes:
I Agree with Terms
*
I understand the terms as outlined above
Name of person submitting form
*
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