Latisys Quote Request

First Name :*

Last Name :*

Email :*

Title :*

Company Name :*

Business Phone :*

Mobile phone :

City:  *

2-Digit State Abbreviation:  *

Zip code :*

Area(s) of Interest: Colocation Managed Services Managed Hosting Cloud Computing Other *

Install Facility Preference: No preference Ashburn Chicago Denver Irvine Other *

Number of cabinets: --None-- < 1 1 2 - 5 6 - 10 10 - 20 > 20 *

Number of Power Circuits: --None-- 1 2 *

Describe Power Requirements:*

Bandwidth Requirements: --None-- < 5 6 - 10 11 - 50 51 - 100 > 100 *

Additional Services of Interest: Managed Storage Managed Firewall Managed VPN Intrusion Detection/Prevention Spam & Anti-Virus Protection Monitoring & Reporting Managed Backup Load Balancing Managed Servers Dedicated Servers Virtualization Connectivity Disaster Recovery Network Device Management SSL Acceleration Portal Demo Partner Program Other *

Describe Solution Requirements:*

Industry --None-- Business Serv: General Business Serv: Healthcare Business Serv: Legal Business Serv: Management Consulting Business Serv: Marketing, PR & Adv Communications Distribution/Transportation Education Finance, Banking, Insurance Government/Non-Profit High Tech: Gaming High Tech: Hosting High Tech: Internet/Web Svcs/Content High Tech: ISV High Tech: IT Services/Hardware High Tech: VAR/Integrator/IT Reseller Manufacturing Other Retail & Wholesale Utilities *

Company Size: --None-- Small (< 50 Emp.) Medium (51-250 Emp.) Large (>250 Emp.) *

How did you hear about Latisys : --None-- Print Advertising Web Advertising Search Engine Article/News Release Postcard/Mailing Email Blast Partner Referral Customer Referral Existing Customer Other

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