Mangaged IT Services Intake Form Managed IT Services Intake Contact Information Your Name * Your Name First First Last Last Business Name * Phone * Email * Address * Address Address Address City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Preferred Method of Contact * TextPhoneEmail Current IT Solutions Do you currently have an IT Service Provider? * YesNo Are you under a formal service agreement or pay as you go? * Service AgreementPay As You Go What does your existing agreement cover? * 24/7/365 Monitoring Automated Software Patching & Updating Managed Antivirus Remote Support Onsite Support Data Backup/Disaster Recovery Managed Cyber Security Network Monitoring & Optimization OtherOther How confident are you in your existing IT Service Provider's ability to provide top tier service? * 0 - Not Confident At All 10 - Extremely Confident 0 1 2 3 4 5 6 7 8 9 10 How many employees do you have that will be using workstations? (Laptops, Desktops, Tablets, ETC) * 0-56-1011-1515-2021-2526+ How many desktops do you have that will need support? * How many laptops do you have that will need support? * How many servers do you have that will need support? * How many printers do you have that will need support? * How many tablets do you have that will need support? * Are there any additional devices not listed above that will need support? * YesNo Please list them here What is the approximate age of the workstations? * Less than 1 year1-5 years5-10 years11 years or older Do you currently have a Data Backup Solution in place? * YesNoNot Sure What type of Data Backup Solution do you have? Local Backup (Hard drives located in the same building)Offsite Backup (Cloud based or other physical location)Not Sure How confident are you in your current Data Backup Solution if a disaster occurred and wiped out all of the data on your workstations?? 0 - Not Confident At All 10 - Extremely Confident 0 1 2 3 4 5 6 7 8 9 10 Have you had any security incidents in the past year? (Hackers, Viruses, Data Leaks, ETC) * YesNoNot Sure To the best of your ability, describe the security incident and the effected it had on the business Do you have an IT problem at present that is stopping your team from working efficiently? * YesNo To the best of your ability, describe the problem(s) and how you would prefer it(them) be resolved. Additional Comments If you are human, leave this field blank. Submit Δ