Network Survey Form  
 
In order to make your installation process as smooth as possible, please have your Network Administrator fill out the following form. We will contact you if we have any questions. If you have any questions or problems while completing this form, please feel free to contact your sales representative.

Your Name
Your e-mail address
Contact Number
Title
Company Name
Address (where your equipment is installed)
City
State
Zip Code
Please Enter Your Sales Rep's Email Address
Number of machines you are purchasing
Expected delivery date
Model(s)
Intended Uses (Check all that apply)
 Printing To Copier  Scanning to e-mail  Scanning to shared folder
In order for your copier to print and scan, it must be installed on your network. therefore, the following information is required from you: (Please use as a checklist)
  Network Drop (please ensure it is active)
  Network cable (COS does not provide a network cable)
  IT Support
Please check the type of IT support you have below:
  No IT support is availiable
  IT Support is In-House
  IT support is subcontracted
Please check the availiablility of your IT support
  IT support is availiable onsite
  IT support is availibale via phone
Network Admin Name
Phone number
To enable printing on your copier, it must have a static IP address. Please enter the IP address(es) you would like to use.
Please enter the Subnet Mask for your network
Please enter the Default Gateway for your network
Please enter the DNS address for your network
Domain or Workgoup Name
Type of Network:
  Peer to Peer
  Server- Client
How many PC's would you like us to load print drivers on? Please note the maximum number of PC's included in your install is 5. If you would like us to load more than 5, there will be an hourly rate assessed.
What additional Equipment will be installed? (HOLD DOWN THE CTRL KEY TO SELECT MORE THAN ONE OPTION)
E-Mail Configuration Information:  
SMTP server name or IP address
Account Address
(This will be shown as the "from" address when scanning to e-mail)  
If your mail server requires authentication for the above account address, please provide the following:  
Account name
Account password
Network Scanning Configuration Information  
Path to shared folder:
(EX: \\PCname\SharedFolder)(A few subdirectories are acceptable. Please add as needed)  
Please Note: The copier(s) requires authentication credentials for Network Scanning. It is strongly recommended that you create a specific user account for the copier(s). The account must have FULL ACCESS rights tot the destination folder and its password should be set to never expire.  
Account Name
Account password
If due to security reasons you cannot disclose some or part of the information above as required for a proper installation with your choice of options, please check the box below. Please note that the aforementioned information MUST be provided at the time of install. If it is not ready, the installation will be rescheduled for a later date when required configuration information is ready.  
  Security reasons prevent me from providing some or all of the info requested. By checking the box I agree to provide all required info to the tech upon arrival.
If you have workstations or servers running operating systems other than Microsoft Windows XP or 2003, please list them in the additional information section below.  
Please enter in any additional information that we may need prior to the install
By submitting this form, the customer acknowledges that the configuration information relative to the installation of the products identified above are accurate and fully disclosed as required and adhere to the customer's satisfaction regarding the scope of work requested