$99 Site Survey

Company Name:      Survey Date:

Address:

Location:      Salesperson:

Contact Information:

Email:

Brief Description of Install: (check appropriate box)

Special Requirements for Mounting:

2) Size of Room: X Feet

3) Drop Ceiling Height: Feet (zero if no drop)

4) Real Ceiling:

   Cement    Projector   LCD Monitor   Camera   "I" Beams   Girders

5) Type of Screen:

   Wall    Ceiling   Concealed Wall   Electric   Manual   Front   Rear  

6) Size of Screen: (V)  X (W)
  Distace from Projector to Screen: Feet

7) Ceiling above the Screen: Clear    Cluttered  

8) If there are beams in the ceiling, how close are they above the projector: Feet
  Which way are they facing?: Parallel    Perpendicular  

9) PLENUM or NON-PLENUM Ceiling? (Open ceiling if not sure!!)

10) Type of Wall construction: Cinder Block   Dry Wall   Plaster   Concret  

11) Will the Customer be supplying electrical power to Equipment (Projector area, Screen, Rack, etc...)?: Yes    No  

12) Union or Non-Union Building?: Yes    No  

13) Any Special Interfacing required?:

14) Input Sources:

15) Are Bulkhead Plates required?: Yes    No   Quantity:
  Labels: Yes    No  

  Label Information:

Is a lift required?: Yes    No
  Widest opening for Lift (measurement): feet (WxH)

17) Is there a loading dock?: Yes    No  

18) Is there a Secure Area to Store Equipment?: Yes    No  

19) Does an Insurance Certificate need to be sent prior to Installation?: Yes    No  
  (If yes, please notify Brenda/Mary and supply them with information.)

Comments:

Projected Installation Date: (IMPORTANT NOTE: The date for installation is determined by the availability of the installation crew and the delivery of the necessary equipment. Please advise the customer of this point.)

Upload any drawings or diagrams below: