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 our automated meter collection tool 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 their 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. An appointment will be scheduled for installation/connectivity of the equipment by our Connectivity Specialist. All fields marked with an asterisk (*) are required. Who is your Account Manager*Don't Know...Denise ReynaEzequiel LuaINTERDEALERIvan DietzJason RichmondJohn GearyJulie Ann LozanoKevin KurtzKevin MagieraNed BresslerOmar ShabazzRyan ReevesScott HarveySteven HoweTim DevencenziVincent DevencenziWayne OHaraContact InformationCompany*First Name*Last Name*Address*City*State*CaliforniaNevadaPostal Code*Phone Number*No dashesFax NumberNo dashesEmail address*Your IT Support Staff*Always OnsiteOffsiteAvailable By Appointment3rd PartyNo IT SupportDoes this equipment replace a current Smile machine?*YesNoDo you have a dedicated outlet for your new MFP(s)? It's a requirement for all MFPs*YesNoDoes this installation require Account Codes (tracking) setup?YesNoWhat physical connection will you be using for the equipment? *CAT5USBWireless Is there an Active Data Port within 6 feet of the equipment? YesNoIf Not 6ft, how far?I would like my Printer Driver to default for?Black and White (Print Driver will print Black and White, unless I choose Color)Automatic (Print Driver will select depending on the file being printed, unless I choose Color or Black and White specifically)Faxing*Analog LineDigital LineNo FaxUsing VOiP to send and receive faxes would be inconsistent with fax requirements and may cause concern. Workstation Operating Systems*MacintoshWindows 10Windows 11What type of Printer Driver installation is required?*Local PCPrint ServerOtherHow many workstations would you like setup to printer?*None1-1011-2021+What is the Subnet of the equipment being installed? *What is the Gateway of the equipment being installed? *What is the IP address to the equipment being installed? *All Windows Server*YesNoI Do Not Have A ServerMail Server TypeHosted (In-house)Microsoft 365GmailOtherScanning*Network FolderDesktopEmail (select option below for Email server type)NoneAuto Meter Collection Tool Contact: Name, and Email or Phone #*Please provide the name of the person who we should contact to install our Meter Reading Software.Technical Contact Phone Number or Email AddressNo dashesTechnical Contact Name*By typing in my name, I hereby confirm the above information to be accurate and agree to the above terms and conditions.Authorized Digital Signature*Email address*Email address*Email address*SendThis field should be left blank
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