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Your name: Mr./Ms___________________________________________________________
Organization:________________________________Dept. __________________________
Your title at organization:______________________________________________________
Telephone:______________________________ Fax:_______________________________
Organization's full address:____________________________________________________
Country:___________________________________________________________________
Date of purchase (Month/Day/Year):_____________________________________________
(*Applies toadapters only)
Product was purchased from:
Reseller's name:_________________________________________________________________
Telephone:_______________________________________ Fax:___________________________
Reseller's full address:____________________________________________________________
Answers to the following questions help us tosupport your product:
1.Where and howwill theproduct primarilybe used?
Home Office Travel Company Business Home BusinessPersonal Use
2. How many employees workat installation site?
1 employee 2-9 10-49 50-99 100-499 500-999 1000or more
3. What network protocol(s) does your organization use?
XNS/IPX TCP/IP DECnet Others___________________________________________________
4. What network operating system(s) does your organizationuse ?
Justcom LANsmart Novell NetWare NetWare Lite SCO Unix/Xenix PC NFS 3Com 3+Open
Banyan Vines DECnet Pathwork Windows NT Windows NTAS Windows'95
Oothers______________________________________________________________________
5. What network management program does your organizationuse ?
D-View HPOpenView/Windows HPOpenView/Unix SunNet Manager Novell
NMS NetView 6000 Others____________________________________________________
6. What network medium/media does your organization use?
Fiber-optics Thickcoax Ethernet Thin coax Ethernet 10BASE-T UTP/STP
100BASE-TX 100BASE-T4 100VGAnyLAN Others______________________________
7. What applications are used on your network?
Desktop publishing Spreadsheet Word processing CAD/CAM
Database management Accounting Others______________________________________
8. What category best describes your company?
Aerospace Engineering Education Finance Hospital Legal Insurance/Real
Estate ManufacturingRetail/Chainstore/Wholesale Government
Transportation/Utilities/Communication VAR System house/company
Other_______________________________________________________________________
9. Would you recommendyour Justcomproduct toa friend?
Yes No Don't know yet
10.Yourcomments on this product?
______________________________________________________________________________
Product Model
Product Serial
Number
* Product installedin type of
Computer
(E.g.,Compaq(486)
* Product installed
Incomputer serial