Customer Information

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Company and Personal Information ::.
Name of the Company*
First Name*
Last Name*
Title / Position
Department
E-mail*
Confirm Email*
Company Main Telephone *		Extension
Alternate Telephone
Fax
Street Address
City
ZIP or Postal Code
Country*

To give us better understanding of your system, please fill in the following Technical Information.
If you wish not to complete the Technical Information, please click the submit button.

Techincal Information (Optional) ::.
Areas you want to upgrade (Use Ctrl. button to select multiple areas)		Other Area
Actual System		Other (Specify)
Version of the System
Number of PC Servers/ Operator Stations
Number of Clients PCs
Current Operating System
PLCs		Other (Specify)
Number of PLCs
Network Type		Other (Specify)
Periphery Topology		Other (Specify)

Additional Information (Optional) ::.
Does this Project have approved budget?	Yes	No
What is the timeframe of implementation of this project?
How did you hear about this offer?		Other (Specify)
Any additional information you would like to share with us.