***Order Commercial Security Design Survey***

Please enter the business information below.

Name: Tax ID Number

Employees: Select One Single Person Two employees Three employees Four Employees Five Employees More than 5 employees but less than 15 More than15 but less than 25 employees More than 25 employees

Please enter the business contact information below.

and or

Telephone: Fax:

Email:

Please let us know how you found ASC.

Search Methods: Select One Internet Search Engine Referral Verizon Yellow Pages Walk In

Search Engine: Select One Current ASC Customer Alta Vista Search Google Search MSN Search Other Search Engine SuperPages.com Yahoo Search

Keyword Search:

I was referred by:

Please check all that apply to your business communications systems.

Telephone Service: Select One Multi-Line System Standard Single Phone Line Service T1 Service VoIP Telephony

Internet Access: Select One None Cable Dial-Up Modem DSL Satellite

Network: Yes, we have a local area network (LAN)

Computers: Select One Yes No

Please check all areas of interest that apply.

Carbon Monoxide Hold Up Medical Issues Thefts

Fire Excessive Heat Smoke Water Freezing

24-Hour Monitoring

Please check all areas of interet that apply.

Access Control Door Controls Intercom System

Panic Alarms Vandalism

Please check or select all that apply.

Property Type: Select One Retail Store Front Strip Mall Business Office Above Street Level Street Level Offices Single Tenant Building Multi-Tenant Building Floors: Select One Zero One Two Three Four Five Six Seven Eight Nine Ten Eleven Twelve Thirteen Fourteen Fifteen Sixteen Seventeen Eighteen Nineteen Twenty

Doors: Select One One Two Three Four Five Offices: Select One One Two Three Four Five More Than Five Zero

Windows Without Bars: Select One Zero One Two Three Four Five Six Seven Eight Nine Ten Eleven Twelve Thirteen Fourteen Fifteen Sixteen Seventeen Eighteen Nineteen Twenty Front Door Style: Select One Wood Metal Glass Wood & Glass Metal & Glass

Rear Door Style: Select One None Wood Metal Glass Wood & Glass Metal & Glass Side Door Style: Select One None Wood Metal Glass Wood & Glass Metal & Glass

Exterior Lighting: Select One None Rear of Building Only Around the Perimter Front and Back Only Rear: Select One None Public Access from Alley Private Alley Access Access from Public Wooded Area Access from Private Wooded Area Access from Main Street

Skylight: Yes No

Roof Hatch: Yes No

Please select your schedule preference for the Commercial Security Design Survey.

Month: Select One January February March April May June July August September October November December Day: Select One Monday Tuesday Wednesday Thursday Friday Saturday Time Slot: Select One 8:00 -Noon Noon- 4:00PM 4:00 - 7:00PM