Site Survey

I hereby affirm that I have the authority to authorize, and I authorize Smile Business Products, Inc. dba Smile Network Services (Smile) to connect the above multifunctional print device and/or printers, scanning software and Page Trac software to our network, based on the network information provided in this site survey. I agree that the installation can be done on our company server(s) and workstation(s) by your staff with my authorization. I agree to indemnify Smile for any post-installation issues that may arise regardless of there origin, and will resolve, or contract with a third party to resolve, any maintenance, repair or support issue that arise after the installation of the multifunctional device.

I will be present for the installation. Please do not connect the equipment to my network if I am not present. Please schedule appointment at the following date and time.

Name of Smile Representative (required)

Company (required)

First Name

Last Name

Phone Number

Email Address

Address

City

State
N/AAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaVirgin IslandsWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundlandNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukonArmed Forces - AEArmed Forces - APArmed Forces - AA

Postal Code

Fax Number

Requested Features
 Automated Meter Data Security Kit Document Management Inbound Fax Routing LDAP/Global Address Search PC Faxing PostScript (required for MAC OS) Printing Scanning User Account/Control Codes

OSA Applications
 DRIVVE Infodynamics/Quickbooks Laserfiche SimplifyScan Sharp E-Mail Connector SharePoint

Server Operating System
Windows Server 2000Windows Server 2003Windows Server 2008Small Business Server 2003Small Business Server 2008I Do Not Have A Server

Mail Server Type
Microsoft ExchangePOP3/Hosted (I.e. GoDaddy, Surewest)Lotus

Operating System on Workstations
 Macintosh Windows 2000 Windows 7 Windows Vista Windows XP

64-bit Operating System
 Yes No

What physical connection will you be using for the equipment?
 CAT 5 USB Wireless (requires Wireless Print Server at additional charge)

Is there an Active Data Port within 6 feet of the equipment?
YesNo

If connection is not within 6 feet, how far? (Additional charge for extended cable length or installation of a data drop)

What is the IP address to the equipment being installed?

What is the Subnet address to the equipment being installed?

What is the Gateway of the equipment being installed?

What applications will you be printing from? Example: Microsoft Excel/Word

Authorized Digital Signature

By typing in my name, I hereby confirm the above information to be accurate and agree to the above terms and conditions.