1. Company
  * [Required]

2. Customer ID
  * [Required]

3. Contact
  * [Required]

4. Union Site
--- Select --- Yes No

5. City permit   * [Required]
--- Select --- No Yes

6. Address

7. Address Line 2

8. City

9. State

10. Zip Code

11. Phone

12. Extension

13. Fax Number

14. Email Address
  * [Required]

15. Zip code of site location

16. Special hours required
--- Select --- Yes No

17. Requested date [mm/dd/yyyy]  

18. Requested time [HH:MM]  

19. Site size: Total sq Ft (If N/A, please give width and height)

20. Width

21. Height

22. Type location

23. Lift required
--- Select --- Yes No

24. If Special lift is required, advise type

25. Camera system will be installed on multiple floors
--- Select --- Yes No

26. How many floors at this site?

27. Site has access areas from floor to floor
--- Select --- Yes No

28. Type of ceiling

29. If open ceiling, what is the color of ceiling?

30. Height of ceiling

31. Type of cameras

32. Qty of inside fixed cameras

33. Qty of inside PTZ cameras

34. Qty of outside fixed cameras

35. Qty of outside PTZ cameras

36. Inside cameras to be mounted on ceiling or side walls

37. Conduit required at site
--- Select --- Yes No

38. Does site have fire walls?
--- Select --- Yes No

39. Type of cable

40. Outside cameras to be mounted on roof, side wall or in parking lot

41. If parking lot, is trench required with conduit?
--- Select --- Yes No

42. If roof, is there proper access?

43. Total length of all cable required for job

44. How far is entrance from DVR?

45. Qty of DVR's to be used

46. Qty of system controllers to be used

47. Will remote access be utilized on DVR?
--- Select --- Yes No

48. How far is the DSL connection from the DVR?

49. Control room has proper ventilation
--- Select --- Yes No

50. DVR to be located on

51. Qty of monitors (non PVM) to be used
--- Select --- Yes No

52. Onsite training to be done
--- Select --- Yes No

53. Will a PVM (public view monitor) be used?
--- Select --- Yes No

54. Qty of PVM's to be used
--- Select --- Yes No

55. PVM is to be installed from

56. What is the distance from the floor to the bottom of the PVM?

57. Please describe any aditional Requirements for this surveillance Installation (Explain in detail)