Customer information form

Customer information
Code		Your e-mail address
Location information
Company name:
Address:		Zip Code:
City:		Country:
General Phone number:		General Fax number:
Technical contact		Network contact
Name:		Name:
Phone number:		Phone number:
E-mail address:		E-mail address:
Building access		Installation & training
Is parking space available:		What is your preferred installation date:
On which floor is the installation planned:		How many people will attend to the training
Is there an elevator available:		Is an Secure ID needed:
Conference room
Room number or name:		120V or 230V voltage:	120V 230V
Dimensions of the room:		Wall material (concrete, wood):
Can the windows be blacked out:	yes no	Wall thickness:
What kind of lighting is installed:		Is there a beamer to install the Video Conference System on, if so, which
Is there a double power socket available:	yes no	brand and type:
Infrastructure
IP Settings		ISDN Settings
IP Assignment:	Static Dynamic	Are ISDN lines available (if applicable) and what numbers:
IP Ethernet speed:	Auto 10H 10F 100H 100F	ISDN lines need to meet these specifications: Euro ISDN Not bundled to one group Network terminators need to be within 25 meters from VC equipment B channels have to support data The lines have to be configured Point to Multipoint
Static IP address:
Static IP subnet mask:
Static IP Gateway
Quality of Service:
H323 ID settings:
H323 ID:
E.164 Alias		SIP settings
Gatekeeper IP address:		SIP URI:
NAT:	Off On	SIP Registrar:
NAT address:		Username:
		Password:
System name:

What kind of phonebook needs to be uploaded into the system:		Remarks: