CORE USER INFORMATION
Name *
Title *
Organization *
Street Address
City
State	Alabama Alaska Arizona Arkansas California Colorado Connecticut D.C. Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip Code
Phone Number *
Fax Number
Email Address *
CORE SYSTEM INFORMATION
Requested Delivey Date
Estimated Quantity
Chassis Model	Custom Design 1U Chassis 2U Chassis 3U Chassis 4U Chassis 5U Chassis 6U Chassis Blade Wall Mount Benchtop Card Cage Desktop Other
Depth Requirement
Power Input	110VAC 220VAC -12VDC -24VDC
Mainboard	Motherboard Single Board Computer
PCI Slot QTY
PCI-X Slot QTY
PCIe Slot QTY
ISA Slot QTY
AGP Slot QTY
CPU Type	Pentium 3 Pentium 4 Pentium M Pentium D Core 2 Duo Xeon Dual Core Xeon Quad Core Xeon Athlon Athlon 64 Athlon 64 FX Athlon 64 X2 Opteron
Required CPU Speed
CPU QTY	1 2 4
Memory	128MB 256MB 512MB 1GB 2GB 4GB 6GB 8GB 12GB 16GB
Video Memory	8MB 16MB 64MB 128MB 256MB 512MB
Ethernet	10/100 10/100/1000
Ethernet Ports
USB Ports	1 2 4 6 8
Front USB	Yes No
Floppy	Yes No
CD or DVDROM	CDROM CDRW DVD/CDRW DVDRW DVDRW DUAL LAYER
Hard Drive Type	IDE SATA/150 SATA/300 U320 SCSI SAS
Hard Drive Capacity	40GB 80GB 120GB 160GB 200GB 300GB 400GB 500GB
QTY of Drives
RAID	None 0 1 2 3 4 5 6 0+1 10
Hot Swap	Yes No
Serial Ports	RS232 RS422 RS485 RS232/422 COMBO RS232/485 COMBO RS422/485 COMBO
Serial Port QTY	1 2 4 6 8 10 12
LPT Port	Yes No
Operating System	Windows XP Windows 7 Windows Server 2008 RedHat Linux SUSE Linux Mandriva Linux FreeBSD Other
Rack Slides	None 15" 20" 26" 32"
Custom Paint	None Yes Front Panel Only
Custom Logo	None Single-Color Multi-Color
CORE DISPLAY INFORMATION
Display Form Factor	1U Clamshell 1U Layflat 2U Clamshell Panel Mount Custom
Display Type	LCD Only LCD and Keyboard LCD, Keyboard and KVM
Display Size	15" 17" 19" 20"
Touchscreen Option	Yes No
Required Connectors	VGA XVGA DVI BNC COMPOSITE
KVM Option	None 2 Port 4 Port 8 Port 16 Port
Depth of Rack
ADDITIONAL INFORMATION
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