» Required Fields
» First Name:
» Last Name:
» Company
Name:
» E-mail Address:
» Phone:
» Address:
» City:
» State:
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Washington D.C.
Delaware
Florida
Fed States of Micronesia
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marianas Pacific
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Virgin Islands (U.S.)
Washington
West Virginia
Wisconsin
Wyoming
AA-APO/FPO
AE-APO/FPO
AP-APO/FPO
» Zip:
» System Type:
» Age of System:
Years
» Current Warranty or Maintenance Agreement:
YES NO
» System Configuration:
Number of incoming
lines and number of phones:
Lines:
Phones:
» Current Voice Support Provider:
» Satisfied
with current service?:
YES NO
» Multiple
Offices:
YES NO
If so, how many?
If yes, do you have a network in place that connects them?
SELECT ONE
YES
NO
» Remote
workers?:
YES NO
If so, how many?
SELECT ONE
None
1-5
6-10
11-20
21-40
41-60
61+
» Do
you have and/or is there a need for video conferencing:
SELECT ONE
Yes, we currently have Video Conferencing
Yes, we need Video Conferencing
No, we do not have or need Video Conferencing
» How
do you communicate with remote/mobile workers
( Cellular, radio, etc. )
Business Cellular Personal Cellular Land Line
Radio Text/Paging Email We Don't
» Voice Mail - Number of Ports:
» Do you use Auto Attendant, etc.:
YES NO
» What
kind of changes are occuring in your business right now:
( e.g.expansion, downsizing, moving, etc. )
SELECT ONE
None
Expanding
Downsizing
Moving
Changing Ownership
» Automatic
Call Distribution - Is there a need for Help Desk or Contact
Center Application?
YES NO
» Current Telco Provider
( Dial tone provider )
SELECT ONE
Qwest
Cbeyond
Integra
Time Warner
McLeod
Vonage
Other
»
Satisfied with current service?
YES NO
»
Current Data Configuration
( e.g. types and number of switches, routers, Windows Server based, etc. )
»
Meeting current or anticipated needs?
YES NO
»
Email
( e.g. Exchange Server, using hosted service, etc. )
SELECT ONE
MS Exchange
Hosted
Open Source
Lotus Notes
Web-based
Other
»
Internet Provider and type of service
( cable, DSL, etc. )
Provider:
SELECT ONE
Qwest
Cbeyond
Integra
Time Warner
McLeod
Vonage
Other
Service:
SELECT ONE
Cable
DSL
T1
Multiple T1
Wireless
»
Satisfied with current service?
YES NO
»
Current IT Support Provider
»
Satisfied with current service?
YES NO
»
Need for remote access to network or applications?
YES
NO
»
Closed Circuit TV Surveillance in place or are you considering installing?
In place
Considering Installing
No Need
»
Card Access Control in place or are you considering installing?
In place
Considering Installing
No Need
»
Does your business require your clients to set appointments?
YES NO
»
Are you aware of new capabilities in United Communications?
YES NO
»
Sound systems requirements?
( e.g. do you have a need for board room sound systems, overhead paging, sound masking, etc. )
»
Do you lease your office space?
YES NO
»
If yes, when does your lease expire?