Technology Site Survey

Fill out the form below or download a printable version and fax to 860.635.5280

Please tell us about yourself: (* denotes required fields)

Company Name *
Date *
IT Admin - Contact *
IT Admin Phone # *
Company Address *
City * State *
Company Phone *
Zip Code *

Do you want to use DHCP?
Do you use MAC Blocking?
Network TCP/IP Address *
Network TCP/IP Subnet *
Network TCP/IP Gateway *
Network Primary DNS *
Network WINS
Network Secondary DNS
Network Domain Name *

If Using Print Server:
Will Print Drivers need to be installed on the server?

Your IT contact needs to be available to load the Print Drivers on the server either onsite or remotely.

If Installing Locally:

How many work stations will be printing to the new device?

Over 5 work stations may result in additional charges- If loading driver locally on each machine, A&A Tech Support needs administrative rights to do so.

Will the Device be connected to a Wireless Network?
Security Type
SSID Password
Does your Wireless Access Point recognize 802.11b? *

Multifunction Options Desired? (Select all that apply.)

The installed device will require full access rights to the Scan Folder. A network User Login Account will be needed. The Suggested Account ID: “savin” Password: “copier” If a scan folder already exists, Please provide complete Scan Folder File Path:

ID: & Password:
Please provide SMTP email server address: Port#:
Does Your SMTP require authentication?  
If Yes, Please provide the following authentication info:
ID: & Password:
Please provide the Administrator Email Address:
(This will be the “sender” from the device to the “User Email Address”-Example: “”)