Technic Site Survey Form-Technic

First Name

Last Name

Email

Phone Number

Copier Account Rep

Company

Address

Stairs (Will your machine need to be placed on a floor that requires it to be lifted up stairs?)

Yes

No

Elevator - Yes

Elevator - NO

If stairs and no elevator, how many steps?

Power Requirements (Do you have the proper power requirements for your new machine)

120V

15 AMP

20 AMP

Onsite Contact Name:

Onsite Contact Phone Number

IT Service Info (Please give your IT notice in advance of our arrival)

If you have Outsourced IT or In-House IT

How many printers or copiers are we setting up for you?

IP Addresses

Subnet

Gateway

DNS

Power Outlet

Network Jack

Computer Count: Please note a $160.00 per hour charge will be applied to any work beyond the 5th computer.

Will printing be controlled by your server? If "Yes" we need credentials to access this Server.

Account Codes?

How would you like to Scan?

Scan to email

Scan to Folder (SMB)

Scan to FTP

No Scan Setup Required

SMTP Email Server (If you would like to scan to Email, you must provide the server name.) Example AOL, GMAIL, O365

SMTP Authentication - User Name (This is normally the email account you want the MFP to send from.)

SMTP User Password (This is normally the email account password.)

SMTP Port (Normally this is Port 25, 465, or 587.)

Email Security

Receive Faxes?

Print Faxes Immediately

Forward Faxes to an Email Account

Forward Faxes to a Shared Folder

I Do No Use Fax

Fax to Email Address (Faxes will forward to this email account when they are received.)

Please note, you must have an analog line for fax.

Yes, we have a "POTS" line, not VoIP.

No, we have VoIP and need to know our options.

TERMS & CONDITIONS:

Scope of Work

Printing: Installation and configuration of print drivers and a print out of a single printer test page will be performed on up to five (5) devices per printer/copier at no charge. (Ex. Two (2) printer/copier devices includes ten (10) devices.

Scan to Workstation/Network folder/Email: Up to five (5) workstation/network folder locations or email addresses will be programmed in the MFP address book and a single test scan will be sent from the MFP to each programmed location at no charge. Installation of File Scan Utility software may be required. (Feature must be selected under requested configuration. Network required information must be provided.)

Scan to Email: Up to five (5) email addresses per MFP will be programmed in the MFP address book and a single test scan will be sent from the MFP to the programmed email addresses at no charge. (Feature must be selected under requested configuration. Network required, and information must be provided.)

Fax: A single fax page will be sent and received by the MFP to test connectivity. Up to five (5) fax numbers per MFP will be programmed in the MFP address book. Fax numbers to be programmed must be provided at time of installation. The location of received faxes will be configured for a single location at no charge. (Feature must be selected under requested configuration. The fax line must be located near the MFP.) Fax requires an analog line, and will not function properly with a VOIP or digital phone line. Network Fax: Installation and configuration of network fax drivers will be performed on five (5) workstations per printer/copier at no charge. A single fax page will be sent from each workstation to test connectivity. (Feature must be selected under requested configuration.)

LDAP: Configuration of LDAP compliant features will be configured on each MFP. The customer's IT support must be available to provide LDAP network configuration settings at time of installation.

Network Installation Terms and Conditions

Installation Deadline: Installation must be scheduled within 180 days from the delivery date. Failure to do so will result in a charge at our Standard Hourly Rate. Visit restrictions: The included network configuration on five (5) workstations must be completed at the time of the initial installation visit. Additional visits for network configuration will result in a charge at our standard hourly rate and a trip charge. Additional configuration requests: Network configurations in addition to the included five (5) workstations per MFP will result in a charge at the standard hourly rate with a one (1) hour minimum at the time of installation and a trip charge. Trip Charges: Travel time is included in the initial network installation. Additional network service requests are subject to a trip charge.

Principal Period of Service: The principal period of service for installation is between the hours of 8:00 a.m. and 5:00 p.m. PST, Monday through Friday, excluding federal holidays.

Force Majeure: Either party shall be excused for delay in the performance of any obligations hereunder when such delay is the result of or attributable to the elements, acts of God, governmental authority, unavailability of parts from manufacturer, delays in transportation or any other cause beyond their reasonable control.

Customer Network Changes: Any changes made to the network that could interfere with the compatibility or functionality of Nevill installed equipment (i.e. IP address, ISP providers, server changes, software changes, movement of workstations, replacement of workstations/laptop, firewall updates/changes, passwords etc.) will result in a charge at the standard hourly rate.

Installation Warranty: 30 day warranty which includes reinstalling of network configuration software on the five (5) workstations configured at the time of the MFP's initial installation.

Incompatible Systems: Technic Technicians reserve the right to deny network services on some customer workstations. Reason's for exclusion include but are not limited to; pc blue error screen's, extremely old computers, Microsoft Windows 98/XP and below, workstations with unstable OS environments, third party firewalls, virus/malware/spyware infections, or other non-supported devices etc.

By submitting this form, I acknowledge that I have read, understand and agree to the Service Terms, Conditions, Scope of Work and that failure to fill out this form will result in the denial of Technic network installation services.

Authorized Company Representative *

Your Signature

*

I agree to the terms & conditions

Technic Site Survey Form

INSTALLATION ADDRESS:

NEW DEVICE INFORMATION:

Print Settings:

Scan Settings:

If you selected "Scan to Email" above, please answer the following:

Fax Setup:

If you selected "Forward Faxes to an Email Account" above, please include the following:

Please acknowledge that you have read and accept the above terms and conditions. *