COMMERCIAL CONTACT FORM

Company Name:
Your Name:
Your Title:	please select President CEO COO CIO CTO VP IT Manager Other
Address:
City:
State:	choose state Alabama Alaska Arizona Arkansas 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
Zip Code:
Office Telephone:
Alternate Telephone:
E-mail: * (required)

Please enter items you wish to have backup power during a power interruption:
Number of Server Computers		Traditional Telephone System
Number of Critical Workstations		VoIP Telephone System
Alarm System		Number of VoIP Extensions
Surveillance Equipment

In an outage, for how long would you need backup power?

please select 3-5 hrs 6-9 hrs 12+ hrs

Do you have an industrial-size battery UPS system?

please select yes no

Do you have a motor-powered backup generator?

please select yes no

How many floors does your building have?

On which floor of the building is your facility/office located?

Does your business have access to a loading dock?

please select yes no

Does your company have a disaster recovery plan

please select yes no

Would you like to receive a brochure?

please select yes no

How did you hear about Banner Power Company?
WTOP Radio	Business Referral
WTOP Website	Direct Mail
WCBS 880 AM	Newspaper Ad
Internet Search	Washington Spaces Magazine
Friend	Other
Washington Gas

Any questions/comments?

Privacy Notice:
The information obtained in this survey is considered confidential and will not be sold or transferred.