Name:

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Business Name:

Phone2 #

Address:

Fax #

Address(cont.):

City:

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E-Mail:

1. How would you best describe your current CCTV needs?

We are looking for a new system We are looking to expand our current system We are looking to replace our current system

2. For what type of location are you looking for a video surveillance system?

Commercial Office Location Convenience store Industrial/Manufacturing Facility Institutional (i.e. Education, Government, etc.) Laundry Mat, Dry Cleaning Medical (i.e. Hospital, Clinic, etc.) Residental (Home Owner) Retail Location Restaurant/Bar/Night Club Other

3. Approximately how many surveillance cameras are you interested in?

1-4 4-8 8-12 12-16 16+

4. Where will the video surveillance cameras be located?

Indoors Only Outdoors Only Both Indoors and Outdoors Not sure

5. What is the approximate square footage of this location?

0 - 2,499 sq.ft. 2,500 - 4,999 sq.ft. 5,000 - 9,999 sq.ft. 10,000 - 49,999 sq.ft. 50,000+ sq.ft. Not sure

6. What is your estimated budget for this system?

Less than $2,000 $2,000 - $4,999 $5,000 - $9,999 $10,000 - $24,999 $25,000+ Not sure

7. What is your buying timeframe for this system?

ASAP 1 - 2 Weeks 2 - 4 Weeks 1 - 2 Months 2+ Months Not sure

8. Please describe any additional requirements or questions you may have

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