MFP Network Site Survey

Please fill out this form and submit.

Account Information

Please tell us about yourself: (

denotes required fields )

Company Name

Date

Key Operator Name

Key Operator Phone

Do you have either an onsite network admin or 3rd party IT?

Yes No

Network Admin Name

Network Admin Phone

Network Admin Email

Network Admin will be onsite during install.

Yes No

Network Information

IP Address for MFP/Printer

Subnet Mask

Gateway

Primary DNS

Secondary DNS

Domain Name

WINS Server

Wireless SSID

Wireless Pass Key

Print Drivers

If Printer is to be installed on each workstation/server or mobile device, please select all operating systems that apply:

Windows/Server Mac OS Android Apple iOS Windows Mobile

Multifunction Options Desired

Select all that apply

Print Scan Fax

Scan To Folder

The installed device will require full access rights to the Scan Folder. A network User Login Account will be needed. If a scan folder already exists, please provide complete file path to existing Scan Folder.

File Path

User ID

Password

Scan To Email

SMTP email server address

Port #

If Your SMTP server requires authentication please provide the following authentication info:

User Name

Password

Please provide the Administrator Email Address:

(This will show up as the Sender address when scanning from the MFP)

Multifunction Extended Options Desired

Select all that apply

Inbound Routing LDAP

Inbound Routing

Email address or Folder Destination to route incoming faxes to:

LDAP Setup

LDAP Server:

LDAP Search ROOT:

Server Authentication Type:

Username

Password

Customer Responsibilities

Data Ports, Network Drops, network cables, USB cables, network switches, and power outlets, and fax outlets are to be provided by the customer. In addition, the customer must provide adequate space and environment for the device to be installed.

THANK YOU FOR YOUR BUSINESS, AND THE OPPORTUNITY TO SERVE YOU!

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