Perle 833 Remote Access
Server Request Form

I would like to…

Purchase
Evaluate
Have a specialist contact me
Have more information sent

Name

Company Name

Address

City

State

Zip

Phone

Fax

e-mail

Servers installed:

AS400 (iSeries)

NT 4.0

W2K Server

Linux

RS6000 (pSeries)

Unix Host

Industry

Manufacturing

Healthcare

Distribution

Government

Retail

Other:

RAS Server requested:

833/2E (2 port Ethernet) 833/4E (4 port)

833/8E (8 port)

833IS (8 port for ISDN)

Number of units you could deploy?

1 2-5 6-9 10+

Timeframe for deployment?

Immediate 30 days 60 days 90+

Who else besides yourself will be involved in implementing/evaluating?

Name:

Name:

Additional Comments