This site is designed using current web standards. The contents of this page are accessible to any browser or Internet device, but the design is only accessible to a browser that supports the current web standards.

Quick Links
   Site Map
   Email Interworks
   Home

Request Information * Required Fields In order for us to serve you better, please complete the following questions: Personal Information *Name: First Last Mr. Mrs. Ms. Miss Dr. Title: Company Name: Street Address: City: 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: *Phone: (area code) phone: Fax: (area code) phone: *E-mail address: What are you requesting? Please send me the following brochures/information (Please Check all that apply): Siemens Hicom 150 Family 3Com Networked Telephony Family 3Com Wireless Networking Products Agere ORiNOCO Wireless Products Voicemail and Unified Messaging Interworks Consulting Services Web Interaction Center OfficeLook Structured Cabling Have an Account Executive contact me: Yes No When is the best time to call? Morning Afternoon Would you like to join our mailing list? Yes No Additional Information that will help us serve you better *How many telephones do you have at this location: *How many telephone lines do you have at this location? Please be sure to include lines used for modems, faxes, credit card readers, etc. How many employees do you have at this location: What brand is your current system? Click to Select AT & T Avaya Intertel Lucent Mitel NEC Nortel Panasonic Siemens Toshiba Other Not sure/don't know Which best explains your reason for considering a new telephone system? Click to Select Company moving Adding new location Growth at current location Current system outdated Need new technology/features Not satisfied with current system Lease expiring other How much is your average monthly telephone bill? Please include long distance charges. Click to Select < $500.00 $501.00 - $1,000.00 $1,001.00 - $2,000.00 $2,001.00 - $3,000.00 >$3,0001.00 How do you connect to the Internet? Click to Select 56K dial up 56K dedicated line Cable Modem DSL LAN/T1 Satellite Other Don't have an Internet connection How would you best describe your business? Click to Select Construction Education Financial/Insurance/Real Estate Government Healthcare Manufacturing Not-for-Profit Religious Organization Restaurant/Food Service Retail Transportation/Communication/Utilities Wholesale Trade other How did you learn about Interworks? Click to Select search engine Internet Link Magazine/Newspaper Radio Telemarketer Fax e-mail Referred by Siemens Referred by 3Com other Comments, questions, or special requirements to help us serve you better.

© 2003 Interworks Systems, Inc. All rights reserved.