Managed IT Services Information Request Form

	Click the SUBMIT button only once when form is complete.
	Contact Information:
	Full Name
	Email Address
	Phone Number
	Business Name
	What type of Industry is your business?
	Is your business service or product based?		Please choose.... Service Product
	Do you have your own IT department?		Yes No
	How many employees?		Please choose.... Less than 5 5-25 26-50 51-100 More than 100
	Are you planning on purchasing hardware?		Yes No
	If yes, when?		Please choose... 3-6 months 6 months - 1 year
	Are you planning on purchasing software?		Yes No
	If yes, when?		Please choose... 3-6 months 6 months - 1 year
	What platform are you using?		Windows UNIX Novell IBM
	Are you using Microsoft Exchange Server?		Yes No
	If yes, What Version?		5x 2000 2003
	Do you have a wireless network?		Yes No
	Have you had a recent security audit?		Yes No