COLO QUOTE REQUEST FORM

Company Name:
* Service Location: Street Address:
* Service Address: City:
* Service Address: State:
* Servie Address: Zip Code:
Service Address: Phone Number:
* Contact Person: Name:
* Contact person: Email Address:
* Contact person: Phone Number:
* How much Space do you need?:	1/2 Rack 1 Full Rack 2 Full Racks 3 Full Racks
* Requested Internet Speed for this Quote - (in Mbps):	1.5 - 3Mbps 3 - 4.5Mbps 4.5 - 10Mbps 10 - 25Mbps 25 - 45Mbps 45 - 100Mbps 100 - 1000Mbps (GIGE)
Please describe any special power requirements:
* Will you be connecting Voice Circuits?:	YES NO
Do you need other managed services with this?:	Streaming Data Backup Tape Back up Remote Hands Operating System Management Application Management Server purhase and/or management & support
Local Loop Requested:	Multiple T-1:|:s DS3 OC3 Ethernet Handoff (100Mbps up to GIGE) Wireless
What Contract Lenght are you willing to sign?:	1 Year 2 Year 3 Year
How soon do you need this Service installed?:	ASAP 1 - 3 months 3 - 6 months 6+ months
Comments & Additional Information:

COLO QUOTE REQUEST FORM