CUSTOMER SITE SURVEY Name of Customer * Name of ABC Sales Rep * Model Of Copier To Be Installed * CUSTOMER INFORMATION Street Address * City * State * TN VA NC KY Zip Code * GENERAL INFORMATION Will there be stairs, step, curbs, or gravel? * If YES Two Technicians will be needed YES NO If this is an upgrade for their existing machine, does the old machine need to be collected by ABC? If YES, enter the brand name of the old machine in the box below YES NO If the old machine is a ABC device what is the ID? IT & NETWORK Does the customer need their current Fax/Email Address Book transfered to the new copier? * YES NO Does the hard drive of the copier need to be removed and left with the customer? * If Other please explain in detail in the box below YES NO OTHER Does the customer have on site IT personnel or a contracted IT service? * MUST be available on site or by phone during install. If parts of the install cannot be completed a service charge may be incurred. YES NO Who will install the copier and needed drivers to each workstation? Appalachia Business Customer's IT Is there a Network in place? * If NO, USB connection is possible with missing features, future networking would be chargeable (ex. Network is not setup YET) YES NO Is there a firewall on this network? * YES NO Does the customer have specific IP settings that they would like used? * If YES please provide the requested network settings below YES NO Is there a WIRED network connection (or FAX connection if needed) within 6ft of where the copier will be located? * If NO this MUST be provided before install. If wireless is needed a dongle must be added YES NO If the connection is further than 6ft, will the customer provide the network patch cable or needed FAX cable? * If NO there is a 1$ charge per foot + possible labor & materials cost YES NO Is there a dedicated power outlet within 5ft of where the copier will be located? * If NO this MUST be provided before install YES NO Number of workstations that need to be able to print to new copier? * If more than 5, ABC IT Support should be present if we are not their IT provider Operating Systems of customer workstations * Check all that apply Window 10 Windows 11 Mac OS 10.6 Mac OS 10.12.6 or Later Linux Distribution SCAN TO EMAIL Will the customer need Scan to Email setup? * If YES these settings must be provided below for ABC at the time of install YES NO SCAN TO FILE Will the customer need Scan to File? * YES NO Does the customer need a login and password for file server access? * If YES please provide the username and password for the file server below YES NO Department Codes Will the customer need Department Codes? * If YES please list departments needed and desired codes in box below BEFORE install YES NO Will there be Color Quotas for each department? If YES please specify the color quotas below for each department YES NO Is there a direct power plug in for the copier? * If NO the customer will be required to sign a waiver making them aware that any damages or issues caused by a faulty power setup may incur repair costs and down time. YES NO Is there a 20 AMP plug? (If one is required by the copier) If YES please indicate in the notes box below YES NO FAX If applicable what FAX system does the customer use? VOIP Fax (FOIP, etherfax etc.) Dedicated Fax Line (phone based) Is this a NEW FAX install? YES NO Customer's Current Fax Number Thank you!