Server Request Form

     Name:  

      Email: 

Company:  

    Phone:  

I would like a:	Tower	Rack
Processor:	Single Dual
Memory:	1 GB  2GB 4GB I'm not sure
Monitor:	17"  19"  None
Disk Size	250 GB  500 GB 1 TB I'm not sure
Disk Type:	Mirror Stripe RAID 5 I'm not sure
Operating System:	Windows 2003 Server Web Windows 2003 Server Standard Windows 2003 Server Enterprise Windows 2003 Server Small Business I'm not sure
This server will be used for: (select all that apply)	Domain Controller Exchange MAS 90 or MAS 200 Terminal Services Nightly Backups Managing Symantec Antivirus Other (hold Ctrl for multiple selections)
Does data need to be migrated off another server?   Yes No
Will the old server be redeployed?  Yes  No
I would like to have the computer installed by the following date:    MM/DD/YYYY
Additional Notes:

Champ Systems, Inc.  Privacy Statement
Champ Systems, Inc. (CSI) is committed to protecting your privacy. This Privacy Statement applies to data collected by CSI through its Web site, as well as its offline support services and billing system. CSI collects and uses your personal information to deliver the services or carry out the transactions you have requested. We also use your personal information to communicate with you. We may send certain mandatory service communications such as welcome letters, billing reminders, information on technical service issues, and other announcements. We may also occasionally send you product/service surveys or promotional mailings to inform you of products or services available from CSI and its affiliates. Personal information collected on CSI sites and offline support services may be stored and is processed in the United States.
Sharing of Your Personal Information
Champ Systems, Inc. will not disclose your personal information outside of CSI and its controlled subsidiaries and affiliates without your consent. CSI will not sell, rent, or disseminate your personal information to any other source or entity unless required by law.