Contact Information

Company

 

Contact

 

Department

 

Position

 

Address

 

Industry

 

City/State/Province

 

Zip/Postal Code/Country

Phone

Fax

 

Email

 

URL

 

 

Project Title

 

 

Project Description / Functional Requirements

   

 

Finance

Do you require financing?

 Yes   No

Leasing Option

 Yes   No

Has there been a budget approved for this project? How Much?

$

Do you have a price range/budget per kiosk enclosure only?

$

Do you have a price range/budget per kiosk enclosure with all hardware included

$

How many Kiosks do you require?

What is your price range/budget per kiosk?

  

enclosure only

 

with all hardware included

 

           Pilot     -     First Foll Out     -     Total Projected
 

Deployment

What is your projected schedule    Start Date   Pilot   Roll Out

Location :

Nationwide    Provincial    Local

What will be the kiosk hours of access?

 

What criteria will you use to determine a successful pilot
 

Hardware Features Required

Minimum PC Required :

Speed Mhz   RAM  Hard drive GB

Modem Network Card Not sure

Telephone Handset :

 Yes   No

Connects To

 

Monitor Size

 13"   15"   17"   19"   21"    Other

Monitor Type

 CRT   LCD   Touchscreen Other

Teleconferencing

Video Conferencing

 Yes   No

Digital Camera

 Yes   No

Printers

 Thermal   Laser   B/W   Colour

 

Signature Pad

 Yes   No

   

Power Outage Monitor/Reboot Device

 Yes   No

   

Uninteruptible Power Supply

 Yes   No

   
 

Payment transactions made by :

   

 Credit/Debit Card   ATM Card(No MC/VIsa logo)   Currency   Coin   Smart Card

Payment transactions through an existing website

 Yes   No

 

Credit Card Magnetic Stripe Data to be Captured

 Yes   No

 

Keyboard

 Onscreen   External

 

With :

 Mouse   Trackball   Touchpad

Security Features (Sensors)

Additional Devices Required

     

Bill Acceptor

Coin Acceptor

Bill/Coin Dispenser

Bar Code Reader

Card Dispenser

Fingerprint IS

Handprint ID

Plasma Screen

Pixel Board

Other :

   

  

 

Housing/Enclosure

Do you have a cabinet/enclosure already?

 Yes   No

     If so,  what make and model is it?

 

Do you have your own design that you would like us to manufacture?

 Yes   No

Is there a specific kiosk on our site whose design you are interested in? Please Specify

Do You Need:

 

   

A"ready to use" (in stock) model?

 Yes   No

 

A custom designed enclosure?

 Yes   No

 

Please describe the features you are looking for in a custom designed kiosk.

 

  

Is this single kiosk required to be ADA(Americans with Disabilities  Act) compliant?

 Yes   No

Do you need exterior graphics/signage?

 Yes   No

Enclosure Location

Indoor    Outdoor    Both   
Public    Secured

Please rate the grade required for the quality of materials and design for the kiosk (see Materials for details)

   

Display (low) grade    Architectural (mid) grade    Exterior Architectural Grade

 

Graphics/Content

Do you need custom designed content?
 OR
Will you be providing the content

   

What percentage of total content/graphics already exist or can be supplied for this project %

Can you supply us any of the following content?

Storyboards

 Yes   No

Graphics

 Yes   No

Attract Loop

 Yes   No

Video Clips

 Yes   No

Screen Savers

 Yes   No

Other Multimedia

 Yes   No

Animation

 Yes   No

Copy/Text

 Yes   No

Audio Tracks

 Yes   No

Audio Scripts

 Yes   No

Do you have existing images saved as :

Gifs    JPEG    MPEG    AVI    Other

If you have an existing website, please provide the following information:

 

URL

 
 

Is you website a source for Content/Graphics?

 Yes   No

 

Does the website you plan to access from the kiosk use pop up windows?

 Yes   No

 

Will your site be used for :  E-Commerce Transactions    Information Only

 

Does your site use :  Flash    Frames

 

Current Operating System

 

Othe (please Explain)r :

 

Do you require application developmen? Please explain
 

 

Connectivity

Internet

Intranet

Other

 

Bandwidth - How fast a connection would be needed?

 

Type of Connection

 

 
 

Additional Revenues (E-Billboards)

Do you want on screen ad capability for promoting your product?

 Yes   No

 

Service

Will you require on site installation?

 Yes   No

Will you require on site hardware repair and maintenance service

 Yes   No

Will you require remote software monitoring/update services?

 Yes   No

Will you require technical support

 Yes   No

 

Source

How did you hear about our company?