QTI: MANAGED SERVICES - SERVICES REQUEST FORM

   QUIETTOUCH Inc.
   145 King. St. W.
   Toronto, ON
   1-866-214-7070 (CA)
   1-866-850-8272 (US)

Please fill in all * required fields. Your Company Information ---------------------------------------------------------------------------------------------------
*Company Name:		Business Type:
Street Address:
City:		Postal Code/ZIP:
Country:		Website URL:
Your Contact Information -------------------------------------------------------------------------------------------------------
*First Name:		*Last Name:
Title:		*Email:
*Phone:		Fax:
Locale of Managed/Colocation Services Needs --------------------------------------------------------------------
*Country:		*Province/State:
*City:		Postal Code/ZIP:
Managed/Colocation Service Requirements -------------------------------------------------------------------------
HOW MUCH SPACE do you require for your colocation services? (e.g. 1000sf, 1 rack, 1 server etc...)
Do you require a private or shared space?
Do you prefer:	Cabinet(s) Cage(s) Room(s)
Do you prefer a carrier-neutral colocation services provider?
Do you need interfacing in a meet-me room?
HOW SOON are you looking to have colocation services?
Other Information ----------------------------------------------------------------------------------------------------------------
Tell us anything else we should know about your colocation services needs:

How did you hear about us?
Referral Publication Direct mailing On the Web Email Other

QUIETTOUCH INC