System Design Request

Project Information

Project Type:

Residential Project
Commercial Project

What does your system require?

Video
Telephone
Data
Audio

Project Name:*

Project Date:

MM

DD

YYYY

Contact Name:*

FirstLast

Phone*

Email*

Company Name

Address

Street AddressAddress Line 2CityState / Province / RegionZIP / Postal CodeCountry

Video Distribution

What type of video are you distributing?

Antenna
Cable
Digital Cable

Is the Receiver in a Rack?

Yes
No

# of TV Locations:

# of TVs with Cable Receivers:

Are you planning on modulating a source with your Cable/Antenna Feed?

Yes
No

Do you have more than one coax feed running to each TV location you would like to modulate to?

Yes
No

Number of HDMI Sources:

HDMI Source Type?

(i.e. Roku box, Satellite Receiver, HD Camera, NVR/DVR Recorder, GamePlayer, Computer, Cable Box, DVD Player.)

Do you have an existing system and wiring?

Yes
No

# of Outputs @ 1'-100'

# of Outputs @ 100'- 200'

# of Outputs @ 200'- 300'

# of Outputs over 300'

Telephone Distribution

Will you have Phone Company Telephone distribution?

Yes
No

# of Lines In

# of Drops

Punch Down Type:

110 Punch
RJ-45

Panasonic/NEC or other (KSU) System OR IP Phone System

Yes
No

Data Distribution

Internet Connection Type:

# of Locations / Computers:

Future Fiber Distribution?

Yes
No

Surge Protection or Power Backup System?

Yes
No

Do you want wireless connectivity?

Yes
No

Will you have an access point?

Yes
No

Would you like the modem inside the panel?

Yes, Include a product holder
No, I don't need a product holder

Audio Distribution

# of Audio Zones:

# of Audio Sources

1
2
3
4

Audio Sound Level Power Options:

100 Watt Per Zone
20 Watt Per Zone

Additional Information:

Please provide any additional information that you feel may help with your custom design

Additional Notes:

Related Files:

Upload any related project files or images.

Project Information

Video Distribution

Telephone Distribution

Data Distribution

Audio Distribution

Additional Information:

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