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Hardware Request Form

MSS IT Solutions

Clinic Name: (*)	Invalid Input
Phone Number: (*)	Invalid Input
Address: (*)	Invalid Input
City: (*)	Invalid Input
State: (*)	Invalid Input
Zip: (*)	Invalid Input
Contact: (*)	Invalid Input
Contact Email: (*)	Invalid Input
Other phone:	Invalid Input
How many total computers will be in the clinic? (*)	Invalid Input
How many total computers would you like quoted? (*)	Invalid Input
How many Desktops?	Invalid Input
How many Laptops?	Invalid Input
How many Tablets?	Invalid Input
Do you need a true server?	Invalid Input
Do you need one of these to be a Server/Workstation? (*)	Invalid Input
Do you need printers?	Invalid Input
What type of printers do you need?	Invalid Input
Do you need a Label printer?	Invalid Input
Do you run wireless in your clinic?	Invalid Input
Are you human?	Invalid Input

" I could be a salesperson for AVImark - the company is great, technical support staff is super - I love the software - if you need to refer new potential users to happy clients....have them call me! "

Angee Baker

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