Company Name*
Contact Name*
Address*
Phone Number*
City & State*
Fax Number*
E-Mail Address*
Basic Phone Info
How many outside lines do you need?
How many telephones do you need?
How many of these telephones need to display phones?
Do you need cordless telephones?
If yes, how many?
Features
Please check all that apply:
Voice Mail
Music On Hold
Automated Attendant
Call Accounting T1
None
Other - please type description below:
When do you expect to purchase this system? (please check one):
ASAP
Within Week
Within the Month
Six Months
Other - Please explain:
Are you authorized to order or are you recommending? (please check one)
Authorized
Recommending
Other - please explain:
Do you want new or refurbished equipment? (please check one)
New
Refurbished
Mixture to keep cost down
Does not Matter
Do you have a specific system in mind? (please select one)
Yes
No
If yes, please explain:
Please explain here......
Do you need installation? (please check one)
Yes
No
If yes, how many wire runs do you need?
Please type other useful information below:
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