About Us Customer Center Service Products Print Management Document Management Supplies Careers Contact Online Site Survey *First Name *Last Name Your Title Company *Email Phone Number () Fax Number () IT Contact (ex. abcd) IT Phone (ex. abcd) Street Address City ZIP/Postal Code Message Model Sharp MX-M350 Sharp MX-M450 Sharp MX-M550 Sharp MX-M620 Sharp MX-M700 Sharp MX-2300N Sharp MX-2700N Sharp MX-3501N Sharp MX-4501N Sharp MX-5500 Sharp MX-6200 Sharp MX-7000 Sharp FO-DC535 Sharp AR-208S Sharp AR-168D Sharp AR-M257 Sharp AR-M317 Sharp AR-M160 Sharp AR-M162 Sharp AR-M205 Sharp AR-M207 Sharp AR-M208N Sharp AR-M237 Sharp AR-M277 Sharp AR-M350N Sharp AR-M355N Sharp AR-M450N Sharp AR-M455N Sharp AR-M550N Sharp AR-M620N Sharp AR-M700N Sharp AR-P350 Sharp AR-P450 Sharp AR-BC320 Sharp AR-BC260 Sharp AR-C330 Sharp AR-C270 Sharp AR-C260M Sharp AR-C160 Sharp FO-DC600 Sharp FO-DC550 Sharp FO-DC525 Sharp FO-DC500 Sharp AR-C200P Sharp AR-C240P Sharp FO-DC500 Sharp AR-C260P Sharp MX-B401 Sharp MX-C311 Sharp MX-C401 Sharp MX-2600 Sharp MX-3100 Sharp MX-4101 Sharp MX-5001 Sharp MX-6201 Ricoh Aficio MP 1600 Ricoh Aficio MP 2000 Ricoh Aficio MP 2016 Ricoh Aficio MP 2020 Ricoh Aficio MP 2500 Ricoh Aficio MP 2550 Ricoh Aficio MP 3350 Ricoh Aficio MP 2510 Ricoh Aficio MP 3010 Ricoh Aficio 2015 Ricoh Aficio 2018 Ricoh 3025 Ricoh 3030 Ricoh Aficio 2022 Ricoh Aficio 2027 Ricoh Aficio 615C Ricoh Aficio MP C2000 Ricoh Aficio MP C2500 Ricoh Aficio MP C3000 Ricoh Aficio MP C2800 Ricoh Aficio MP C3300 Ricoh Aficio MP C3500 Ricoh Aficio MP C4500 Ricoh Aficio MP C4000 Ricoh Aficio MP C5000 Ricoh Aficio MP C6000 Ricoh Aficio MP C7500 Ricoh Aficio 3224C Ricoh Aficio 3228C Ricoh Aficio 3235C Ricoh Aficio 3245C Ricoh Aficio MP 4000 Ricoh Aficio MP 5000 Ricoh Aficio MP 3500 Ricoh Aficio MP 4500 Ricoh 3035 Ricoh 3045 Ricoh Aficio MP 6000 Ricoh Aficio MP 7000 Ricoh Aficio MP 8000 Ricoh Aficio MP 9000 Ricoh Aficio MP 1100 Ricoh Aficio MP 1350 Ricoh Aficio W3600 Ricoh Aficio SP W2470 Ricoh Aficio SP C22X Ricoh Aficio SP C400 Ricoh Aficio SP C410 Ricoh Aficio SP C411 Ricoh Aficio SP C420 Ricoh Aficio SP C811 Ricoh Aficio CL7200 Ricoh Aficio SP 3300 Ricoh Aficio SP 4100 Ricoh Aficio SP 4110 Ricoh Aficio SP 5100 Ricoh Aficio AP610 Ricoh Aficio SP 8100/8200 Ricoh Aficio SP 9100 Ricoh Aficio 1515 Ricoh Aficio MP 161 Ricoh Aficio SP C210 Ricoh AC104/204/205 Ricoh Aficio SP 1000 Ricoh Aficio SP 3200 HP Laserjet M1319 HP Laserjet M1522 HP Laserjet M2727 HP Laserjet M3035 HP Laserjet M4345 HP Laserjet M5035 HP Laserjet M9040/9050 HP Color Laserjet CM1312 HP Color Laserjet CM2320 HP Color Laserjet CM3530 HP Color Laserjet CM4730 HP Color Laserjet CM6030/6040 HP Color Laserjet CM8050/8060 Do you have industry specific software? N/A Do not know Yes No On which server OS will the printer driver be installed? Windows 2003 Windows 2000 Windows NT UNIX/LINUX NOVELL Peer to Peer Windows 2008 What Operating Systems will the imager be installed on? Windows Vista Windows XP Windows 2000 Windows NT Windows 98 UNIX/LINUX NOVELL MAC Do not know What is the IP address for the Imager/Printer: (ex. abcd) What is the subnet mask for the Imager/Printer: (ex. abcd) What is the Gateway for the Imager/Printer: (ex. abcd) Is there an open working network jack within 6ft? N/A Do not know Yes No If no, what is the distance to the jack? (ex. abcd) Do all computers have working CD ROM drives? N/A Yes No No, but has USB port Do not know How many stations will be set up to print by Allfax? Select 1 2 3 4 5 6 7 8 9 10 Do wish to SCAN TO EMAIL? N/A Do not know Yes No The next 2 fields must be filled out in order to set up SCAN TO EMAIL. What is the address of the SMTP server? (ex. abcd) What is the email address to be given to the Imager? (ex. abcd) What is the DNS server IP address? (ex. abcd) If mail server requires authentication, please put username and password in notes below. How many email addresses will be set up by Allfax? Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Email addresses to be set up: Do you wish to be able to FAX from the PC?(Requires the Fax Expansion Kit) N/A Do not know Yes No If yes, how many stations for PCFax? Select 1 2 3 4 5 6 7 8 9 10 Do you wish to use Inbound Fax Routing? N/A Do not know Yes No If yes, what is the email address to be routed to? (ex. abcd) *Meter collection software (FMAudit) will need to be installed on a computer or server that is always on. Will we be installing it on a server or computer? Server Workstation Server/Computer to install meter collection software Sales Representative Select Steve Collura Lucille Brehm Steve Mills Mac McElroy Stephen Faucheaux Hope Landry Skip Nagin Danny Kiper Sheena Vicknair Mitchell Smith Thomas Daniel Notes: Network installations and reconfigurations are performed free of charge within the first 30 days of imager install. Any network configurations after the 30 days are subject to charge unless Connectivity Contract is purchased. If you would like to view what is covered, the Connectivity Contract Terms and Conditions can be viewed on the Service page. *Would you be interested in the Connectivity Contract? Yes No, not interested No, have own IT support Maybe, need more information *Required Fields