In order to fulfill your request, please fill in the following information:

Company Information	* Indicates mandatory fields
Client ID Number:
Company Name: *
Address: *
City: *
Province: *	Please Select Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon
Postal Code: *
Hours of Operation: *	From: To:
Open at Noon   Closed at Noon
Contact Person
Salutation: *	Mr. Mrs. Ms. Miss
First Name: *
Last Name: *
Phone Number: *
Fax Number:
E-Mail Address: *
Network Information
What make/model of equipment do you want to add to the network?
What kind of computer operating system do you use currently?	Windows XP Macintosh OS X Windows 2000 Macintosh OS 9 Windows 98/95 PC Windows NT 4.0 WS Other:
Are the computers networked?	Yes No
What network cabling scheme are you using?	Ethernet 10/100BaseT - RJ45 Ethernet - coaxial Token Ring
Customer Prep:	Power is in place Fax line is in place Spare port available on hub? Cable length required from copier to port
Network cable is Customer's Responsibility. For a nominal fee of $25.00 we will provide cable, up to 25 feet long. Longer cable runs will be installed for a fee of $129.95 per run.
Type of Network Server: Please note: Being connected to the Internet via either Telus or Shaw does not qualify as a network!	Microsoft NT / 2000 Server Microsoft XP Novell NetWare Server Windows 9x peer style network Other:
What Network protocols do you use?	TCP/IP NetBEUI IPX/SPX Other:
In order to scan to e-mail or FTP with the new Cypress equipment a valid TCP/IP address will be required as well as an anonymous SMTP e-mail server connection and an address of the FTP server.
TCP/IP (eg. 192.168.1.123):
Subnet Mask:
Gateway:
Mail Server:
FTP:
What applications do you print from?	MS Office Suite WordPro Microsoft Word WordPerfect Microsoft Excel Corel Suite Microsoft PowerPoint AutoCad Lotus Smart Suite Quattro Pro Lotus Notes
Preferred Network Installation time/date:	Same day as hardware delivery We will call Cypress, when we are ready Make appointment with our IT person:   Name:   Phone:
Additional Comments: