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1. Postal Code or Zip Code for location where work needs to be performed?

2. What type of cabling or wiring service do you need?
	CAT5 / CAT5E
	CAT6
	Fiber Optic
	Voice/Telephone
	Security/Surveillance
	Not Sure
	Other (500 character maximum)

3. Total # of cable drops (including data & voice cabling):
	0-5
	5-9
	10-14
	15-19
	20-29
	30-49
	50-69
	70-99
	100-199
	200+

4. When does work need to be completed:
	ASAP
	Within a few weeks
	Within a few months
	Within 3 to 6 months
	In more than 6 months

5. Type of network connection(s) needed:
	Both Data and Phone
	Data only
	Phone only
	Not sure

6. Type of construction where work needs to be performed?
	Commercial office space
	Warehouse
	Residential
	Outside (mobile office/trailers, external cabling, etc)
	Not sure

7. Will multiple floors within office(s) need to be cabled?
	No - Cabling/Wiring is for one floor only
	Yes - Multiple floors will need to be connected
	Not sure

8. Additional products & services needed:
	Fiber Optics
	Phone system
	Floor rack
	Wall rack
	Patching Panel
	Other (500 character maximum)

9. Please describe in detail any additional requirements you may have for this cabling/wiring project.

PRIMARY CONTACT INFORMATION
Full Name:

Primary Contact Email :

Confirm Email :

Telephone Number:

Fax :

Please be advised that a representative from Connectivity Solutions will be in contact with you within 24 hours.

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107 Westland St. St. Catharines, ON L2S 3X6 | Tel: 289-999-1005 | Toll Free: 877-453-2156 | Email: info@connectivitysolutions.ca

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