Name: Title: Company: Email: URL:   Address line 1: Address line 2: City, State, Zip: Telephone: Fax: Services interested in (check all that apply): Network Email Upgrade(s) Internet Web Development Repair/Service Database Consulting Cabling Accounting Solutions Do you currently have a network? Yes No Operating System     If other please specify:   Pick One Novel NT Unix Other   Platform       If other please specify:   Pick One Intel Alpha Other   Other comments- please be specific: How soon would like to complete the service(s) Within the next month 1-3 months 3-6 months 6-12 months Have you worked with us in the past? Yes No

65 North Plains Industrial Road   |   Prestige Park - Unit 3 Wallingford, Connecticut 06492 (p) 203.949.9900   |  (f) 203.949.9901