Please enter the information requested below for a complimentary onsite evaluation. Once we receive your request, a sales representative will be in contact with you to arrange an appointment.

(Note that fields in RED are required.)

First Name:
Last Name:
Title:
Company:
Address 1:
Address 2:
City:
State/Province:
Zip/Postal Code:
Country:
Email Address:
Daytime Phone:
Fax:

What services or solutions are you interested in?    (Please check all that apply)
Onsite Support / Admin.	Intranet
Voice/Data Cabling & Wiring	Onsite Training
Email	Groupware
LAN/WAN Installation	Internet Access
Virtual Private Network	Data Backup
Fault Tolerance	Remote Access
Resource Sharing	Network Security
Telephone Systems	Digital Video Security
Other (Please describe below) How soon do you need the service or solution you requested? ASAP 1-3 months 4-6 months 7-9 months >10 months What is your company's budget for the requested service or solution? <$5,000 $5,000-$9,999 $10,000-$19,999 $20,000-$29,999 $30,000-$49,999 $50,000-$60,000 >$60,000 How many computers does your company have (IBM PC or compatible, UNIX workstation, Mac, etc.) <10 10-20 21-30 31-50 51-100 >100 How many office sites does your company have? 1 2-5 6-10 >10 What Operating Systems does your computers have?    (Please check all that apply) Windows 9x Windows NT Windows 2000 Windows XP Windows 2003 Unix Linux Macintosh Other   Would you be interested in USWired's support service for maintaining, servicing, or administering your local or wide-area network and computer systems? Yes No If you answered yes, how many hours of onsite support would you need on a weekly basis? <8 hours 8-12 hours 13-16 hours 17-20 hours >20 hours