Name

Company Name

Address

City

State

Alabama Alaska Alberta Arizona Arkansas British Columbia California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northwest Territories Nova Scotia Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Yukon

Zip

Phone

Fax

e-mail

Servers installed:

AS400 (iSeries)

NT 4.0

W2K Server

Linux

RS6000 (pSeries)

Unix

Domino

S390 (zSeries)

Current AS400 model/s installed:

400

7XX

6XX

270

Other:

OS400 Version/s:

3.2

4.4

4.3

Other:

Reason for upgrade: (check all that apply)

Other:

Timeframe for deployment?

Immediate 30 days 1-3 months 4-6 months 6+ months

Who else besides yourself will be involved in inplementation/evaluation?

Name: Name: