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High-Speed Connectivity - Needs Assessment

EZNET provides full Web solutions. We offer full database, commerce, and customized Web-based solutions.

Because each job is unique, please complete this form and a sales representative will contact you. The Sales representative will schedule a face-to-face meeting to see how EZNET can meet your Web-based needs.

If your computer doesn't support forms, you can print out and fax this offline form

Contact Information

City, State, Zip
Phone Number:
Fax Number:

What is the best way to contact you?
Phone E-mail

Company Information

What is the nature of your business?

Is your company currently using the Internet?
Yes No

Who is your current Internet Provider?

How many dial-up connections do you have?

Do you have a dedicated high-speed connection?
Yes No

What type of access are you using?
ISDN  Wireless  Frame Relay   Full T1   Other

What type of access are you interested in?
ISDN  Wireless  Frame Relay   Full T1   Other

What type of CSU/DSU are you using?
Make  Model 

What type Router are you using?
Make  Model 

Do you have a lan?
Yes  No

What type of Network Operating System are you using?
Novel Lantistic Windows
Unix NT Other

Is your LAN TCP/IP compliant? Yes  No  Don't Know

Do you have a Domain Name? If yes, what is the address?

Do you have a Web site? Yes   No

Where is it currently being hosted?

Who would be involved in the decision making process?

Do you have a budget for this project? yes no

What is your time frame/deadline for this project?

Please list any additional information that you feel may be useful in assessing your needs or concerns regarding this project, etc.

St. Marys Hospital

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