Network Request Form

Please provide the following contact information:

Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
FAX
E-mail

Internet Service Provider?

Comcast     Verizon     Roadrunner  AOL       
Other       

Is your service?

Cable    DSL      Dial-Up  

How many computers would you like to network?

2    3     4     5     6     7     8

Operating System(s)? (Please check all that apply)

Windows XP    Windows 2000  Windows ME    Windows 98  
Other   

What would you like your network to do? (Please check all that apply)

Share Internet       Share Files     Share Printers/Other Devices  

Please tell us anything about your computer that you think would be helpful. (i.e.: How old, how much memory, what type of problems you are experiencing.)

How would you like us to contact you?

Email Phone

What is the best time to contact you?

Morning Daytime Evening