*First Name *Last Name Initial

*Address     

*City             *State *Zip

*Phone                                       Fax Number  

 Email Addr    Do you have: DSL Cable Dialup

 What system would you like installed? No Installation To Be Done - Self Install Install Analog CCTV System Install Digital MS Encoder Software Install Digicam Software Install Analog Hardware w/Digital System - Encoder Install Analog Hardware w/Digital System - Digicam

 Your payment will be? Select One Check Money Order Credit Card

If we are installing this cctv system please describe the job to be done, otherwise skip this section. Is this for a residence or a commercial building or office? How many cameras to install? How many feet of wire per camera? Is this an external or internal wiring job? Are these cameras for inside or outside the premises? Describe where the cameras will be installed. Do you want night vision? What size lens do you want? Would you like motion sensors with floodlights installed? How many monitors do you want - TV or small LCD or large plasma screen? Do you want an internet, local or both installation? Do you want to record digitally on a PC, a cctv VCR or both? Do you have any special instructions or requirements? WRITE HERE:

NOTE: If you are ordering a website, you will be contacted to collect website requirements and content info..

Services: I want telecast to install my system Yes No

Services: This is a Residential Commercial installation No Installation

Services: I want a Biz website Yes No     NOTE: 1 year payable in advance $600.00

DESCRIPTION                        ITEM#                               QUANTITY                    INSERT PRICE

1. Biz Website                     None TT001 TT002 TT003 TT004 TT005                          0 1 2 3 4 5 Call Us                   

2. Installation                      None Analog Digital - MS Digicam Biz Quote Required       0 1 2 3 4 5 Call Us                   

3. Analog Purchases           None THW-001 THW-002 THW-003 THW-004 THW-005 THW-006 THW-007 THW-008 THW-009 THW-010 THW-011 THW-012                      0 1 2 3 4 5 Call Us                   

                                           None THW-001 THW-002 THW-003 THW-004 THW-005 THW-006 THW-007 THW-008 THW-009 THW-010 THW-011 THW-012                      0 1 2 3 4 5 Call Us                   

                                           None THW-001 THW-002 THW-003 THW-004 THW-005 THW-006 THW-007 THW-008 THW-009 THW-010 THW-011 THW-012                      0 1 2 3 4 5 Call Us                             

4. Digital Purchases            None THW-008 THW-009 THW-013 THW-014 THW-015 THW-016 THW-017 THW-018 THW-019 THW-020                      0 1 2 3 4 5 Call Us                   

                                           None THW-008 THW-009 THW-013 THW-014 THW-015 THW-016 THW-017 THW-018 THW-019 THW-020                      0 1 2 3 4 5 Call Us                   

5. Hardware Purchases      None THW-021 THW-022 THW-023 THW-024 THW-025 THW-026 THW-027 THW-028 THW-029 THW-030                      0 1 2 3 4 5 Call Us                   

                                           None THW-021 THW-022 THW-023 THW-024 THW-025 THW-026 THW-027 THW-028 THW-029 THW-030                      0 1 2 3 4 5 Call Us                  

6. Software Purchases        None TSW-001 TSW-002 TSW-003 TSW-003A TSW-004 TSW-005                    0 1 2 3 4 5 Call Us                  

                                           None TSW-001 TSW-002 TSW-003 TSW-003A TSW-004 TSW-005                    0 1 2 3 4 5 Call Us                  

                 Shipping Charges (will be calculated after we review the order):   

                 State Sales Taxes (where applicable will be applied):                   

 ESTIMATED TOTAL:                                                                                         

 NOTE: eMail us at sales@info-site.biz for any other cctv requests not included on this form or email us at  support@info-site.biz if you have problems with this form. Thank you for your order.