Close Preview Window Corporate Headquarters: 24 Terry Avenue Burlington, MA 01803 Phone: (800) 869-9390 Fax: (781) 273-9087 customerservice@nbminc.com Branches Boston, MA Canton, MA Bedford, NH more details > Need more information? Please just fill out the form below and someone will contact you as soon as possible. Customer Information *Company *Street Address (ex. abcd) City State Select a State N/A Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Ontario Quebec Nova Scotia New Brunswick Manitoba British Columbia Prince Edward Island Saskatchewan Alberta Newfoundland and Labrador Armed Forces - AE Armed Forces - AP Armed Forces - AA Zip Code *First Name *Last Name *Email Address Contact Title Select a Contact Type Technical Sales Billing Support Friend Phone Number () Network Administrator (ex. abcd) Phone Number (ex. abcd) Proposed Product Product Model (ex. abcd) Dealer Contact (ex. abcd) Controller Model (ex. abcd) Contact Phone (ex. abcd) Expected Connection Type Network Serial Parallel USB Other: (ex. abcd) Does customer have sufficient nodes on network license to add this printer connection? N/A Yes No Is a network connection available for the installation? N/A Yes No If NO: When will the network connection be ready? Date: (ex. abcd) Workstations: Number of clients that will be printing: (ex. abcd) Number of clients that will be scanning: (ex. abcd) Scanning Method: Scan to workstation Scan to local email server Scan to FTP server Protocol: check all that apply IPX/SPX- Frame Type AppleTalk- Default Zone NetBEUI TCP/IP (Please Provide IP Information) Available IP Address: Subnet Mask: Gateway Address: Network Topology/Cabling: Ethernet: 10BaseT 10Base2 10Base5 100BaseT AppleTalk: PhoneNet 10BaseT 10Base2 Token Ring: N/A STP UTP Client Operating Systems: check all that apply Windows 98 Windows NT Windows XP Mac OS 9 Unix Windows for Workgroups Windows ME Windows 2000 OS/2 Mac OS 10 Installation: Name of Customer Contact doing the actual network printer configuration: Name (ex. abcd) Title (ex. abcd) Phone (ex. abcd) *Required Fields

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