Selects equipment request form

Selects equipment request form
Site ID*
Site Name*
Region*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Shipping Contact Name*

First NameLast Name
Shipping Contact Email*
example@example.com
Shipping Contact Phone*
Equipment Information
Camera Equipment

(1 camera per workstation, 1 over locker area, and 1 over administration station)
DVR Camera (analog)
PEA-S15DVRCameraNTSC
DVR Camera Cable
Item #PEA-S12DVRCOAXCBL
DVR Camera Power Supply
Item #PEA-S12DVRPWRSPLY
IP Camera (use with CMVR, built-in microphone)
Item # PEA-S15EEIPCameraDM08
IP Camera Ethernet Cable (use with IP camera)
Item #PEA-S1575-CAT6
DVR / CMVR Equipment
4 Camera DVR
Item #PEA-S12DVRHPPRODSK-3-IM4
8 Camera DVR
Item #PEA-S12DVRHPELITEDSK-IM8
16 Camera DVR
Item #PEA-S12DVRHPELITEDSK-IM16
8 Camera CMVR
Shipped via Eagle Eye
8 Camera CMVR Switch (if using IP cameras)
Item #PEA-S15EESW10PoE8Port
16 Camera CMVR
Shipped via Eagle Eye
16 Camera CMVR Switch (if using IP cameras)
Item #PEA-S15EESW18PoE16Port
26 Camera CMVR Switch (if using IP cameras)
Item #PEA-S15EESW26PoE26Port
DVR Microphone (can use with CMVR for site to hear noise in the testing room)
Item #PEA-S12DVRMICROPHONE
DVR Monitor
Item #PEA-S20MONHPE243
DVR Speakers
Item #PEA-S25-T15-WIRELESSSPKR; new model #PEA-S25-T60-WIRELESSSPKR
Admissions Equipment
Webcam
Item #PEA-ESP-C920E-WC
Signature Pad
Item #PEA-ESP15BIOEPAD
Palm Vein Kit
Item #PEA-S15BIOPVEINKIT
USB Hub
Item #PEA-S30PERUSBHUB
ID Scanner
Item #PEA-S25IDSCANNER
Additional Equipment

(only requested on an exceptions basis)
DVR (without an EZ Watch card)
Item # PEA-S12DVRHP-Z2-G5-IM16
4 camera EZ Watch card (card only)
Item #PEA-S12DVREZWTCH4PCL
8 camera EZ Watch card (card only)
Item #PEA-S12DVREZWTCH8PCI
16 camera EZ Watch card (card only)
Item #PEA-S12DVREZWTCH16PCI
PTE Headphones
Item #PEA-PLT455USBHS
Palm vein sensor
Item #PEA-S15BIOPVEINSNSR
Palm vein handguide
Item #PEA-S15BIOPVEINGUIDE
Palm vein USB cable
Item #PEA-S15BIOPVEINCBL
430P Components
Item #PEA-S12-EEREP-CMVR430COMP
430P Dongle Cables
Item #PEA-S12-EEREP-430PDongle
330P Dongle Cables
Item #PEA-S12-EEREP-330PDongle
Requester*

First NameLast Name
Requester Email*
example@example.com
Date Requested*

MonthDayYear
Date
Case Number*
Additional Comments
Should be Empty:

Selects equipment request form

Equipment Information