Remote Installation Form

Company Name
Street Address
Contact Direct Dial #
Primary Contact
Email Address
IT Contact Name:
IT Company(if applicable)
IT Contact Email Address
IT Contact Direct Dial Number
Network Operating
Network Configuration
Workstation Information
Printer Languages Used
Windows64bit32bitMAC OS versionAS400UNIXPeer to PeerOther:
Ethernet 10 / 100WirelessOther


Available: IP AddressNot Available: Drivers loaded locally

Windows 64bit
Windows 32bit
PCLPost ScriptleTalkAS400 – SCS / AFP / IPDSOther

Server Information
Purchased Software to be installed:
MFP Applications to be set up:
Subnet Mask
DNS Server IP/Hostname
LDAP Server IP/Hostname
SMTP Server IP/Hostname
Environment Verification

Network connection near machine location**

** 2 Network drops may be necessary **

Space Requirements Confirmed

Electrical Requirements Confirmed

AutostoreGlobalScanPrescribeDMConnect ProPinpoint ScanTeaching Asst2MyInbox
Scan to EmailScan to Network FoldersScan to HDDNetwork Fax ForwardingAccount CodesUser Authentication/SecuritySecure PrintPrint to Virtual MailboxInitial Color Calibration/SetupFiery Command WorkstationFiery VUE

NEMA 5-15R 115/120 15 Amp
NEMA 5-20R 115/120V 20 Amp
NEMA 6-20R 220V 20 Amp
Please enter # of licenses that were purchased on the line next to the software. (Note: This is not a sales agreement. Quantities will be verified by the sales order agreement.) American Business Machines will load and program the above software according to manufacturer’s guidelines with the inclusion of professional services charges. Most software requires Business level operating systems. A member of our Solutions Team will be in contact prior to the installation if additional information or a formal scope of work is required.

Multiple Copiersyesno
Same Configurationyesno
Equipment to be Removed
New Equipment
IP Address
Make / Model
Serial #
Tag #
Make / Model

American Business Machines Provides The Software and Drivers for the Purchase equipment in the environment described above and will ABM will install free software that will install them on 3 workstations and/or a print server. Additional workstations needed at the time of install or at a later date are chargeable. If the above network configuration changes after the initial installation and those changes require ABM to reconfigure the software or hardware programming, that service is also chargeable. Customer confirms that they have current backup sets of responsible for providing a functional network and associated hardware for connectivity, network share folders with the proper access control settings and an email account to be used for scan to email. Completion of this form will help American Business Machines to confirm compatibility prior to installation.

Automated Meter Collection
To simplify the meter collection process automatically transmit the serial number and meter readings back to ABM each month. If you would like to opt out of this service check the box below. Should you opt out, meter readings for all units become the responsibility of the customer and are due on the 1 day of each month. Failure to report will result in late fees of $25.00 per incident.Declined

American Business Machines Service Dept. Use Only

Approved By:
ABM sitesurvey

Version 2/27/13

Multiple Copiers yesno
Same Configurationyesno
Equipment to be Removed
New Equipment
IP Address
Make / Model
Serial #
Tag #
Make / Model