CCTV Site Survey Form

Customer # _____________________
Name _____________________
Phone number _____________________
Please fax completed form to our sales department at 864-
286-4942. Or call 1-800-964-8994 with any questions.
Email address _____________________

How would you describe your current video surveillance Camera Power
needs? 120VAC
Looking for a new system 24VAC
Looking to expand current system 12DC
Looking to replace current system
Is Vandal proofing required?
System Application Yes
Indoors only No
Outdoors only
Both indoors and outdoors What transmission method will you be using?
Not sure Coaxial
Fiber Optics
Location of Cameras - indicate number required at each Twisted Pair
location. Not sure
Interior
Parking Lot What are your DVR storage requirements?
Perimeter 5-10 days
Hallways 10-30 days
Building 30-45 days
Other ( please specify) 45+ (please specify)

Do you require IP cameras?

Will any of these be Pan/Tilt/Zoom (PTZ) cameras? Yes
Yes (please indicate qty) No
No
Will remote viewing be required?
Total number of cameras your system will require Yes
1-3 No
4-7
8-15 Will this system be used with Point of Sale?
16-31 Yes
32+ (please specify) No

What lighting conditions will you need to record in? Monitor Size
Daylight/continuously lit 9" - 14"
Night 15'' - 19"
Day and Night 20" - 26"
Not sure 26'' - 32"

Lens type (specify qty of each) What is your estimated budget for this video surveillance
Wide Angle system?
Normal $2,000 - 4,999
Telephoto $5,000 - $9,999
$10,000 - $24,999
Camera Housings/Brackets (specify qty of each) $25,000+
Indoor Not sure
Outdoor
What is your buying timeframe for this system?
Camera Mounting (specify qty of each) ASAP
Wall Within the next month
Ceiling Within the next two months
More than two months