
© 2002 Océ-USA Service Documentation May, 2003 Page 1 of 4
IP4500
Seiko IP4500 MKII SITE SURVEY
Order Number ________________________________
Site Information
Customer Name: ____________________________________________________________________________
Department: _______________________ Floor: ___________________________ Room/Suite: ________
Address: ___________________________________________________________________________________
City: _________________________________________ State: ________________ Zip:_______________
Contact Name (1): _____________________________ Phone: _______________ Ext:_______________
Contact Name (2): _____________________________ Phone: _______________ Ext:_______________
Region: ____________________ Branch: _______________ Service Zone: c 1 c 2 c 3
Inspection Date: ___________________________ Requested Install Date: ________________________
REPLACEMENT EQUIPMENT:
Make: ____________________ Model: __________________ Serial Number: _______________
To Be Removed By: c Customer c Océ* c Contractor/Third Party
Special Instructions: ___________________________________________________________________
*If exsisting equipment is to be removed by Océ, additional labor will be invoiced at current published service rates.
Current Equipment
Delivery Requirements
Is a certificate of Insurance required by building management to make a delivery or pick up? c Yes c No
Is a loading dock available? c Yes c No Delivery hours? _______ to _______
If not, list building entrance dimensions (list dimensions in inches): Height: _________ Width:________
Door Width: ____________ Corridor Width: _____________ Step Width: ______________
minimum width 40" crated - 34" uncrated
# of steps (outside): ______________________ # of steps (inside):
Stair Crawler Required? c Yes c No Number of floors: _____________
Will an elevator be used? c Yes c No Elevator hours? _______ to _______
Elevator appointment required? c Yes c No If yes, contact name & phone
Elevator Dimensions (in inches): Width: _________ Depth: ________ Load Capacity: _______
Elevator Door Opening (in inches): Height: _________ Width: ________
Customer to move fixed obstructions prior to installation unless special arrangements are made. If "No," list
specifics, contact name and phone number. _______________________ c Yes c No
Will floor protection be required? (machine weight - 341 lbs / crated - 484 lbs) c Yes c No
Has the floor condition been confirmed satisfactory by the customer? c Yes c No
Customer Signature: _______________________________________________________________________
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