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	*required fields
About you :
First name *
Last name
Company
E-mail *
Telephone *
Fax
Your project
Please, decribe your project *	Video surveillance Web site broadcasting Video conferencing Other
Required camera type *
	Indoor use
	Fixed camera	Qty *
	PTZ camera	Qty *

	Outdoor use
	Fixed camera	Qty *
	PTZ camera	Qty *

I would like to record the images *	yes	no
I would like to watch the images from a PC located on the same local area network *	yes	no
	If yes, please provide us with the network type :
	10/100 base T
	Wifi
	CPL
	Other
I would like to watch my camera from a remote site*	yes	no
	Type of internet connection ( network camera site):
	Broadband
	Analog modem
	ISDN
	GPRS
Additional comments
Estimated purchase date	Within 30 days
	Between 30 and 90 days
	More than 90 days

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