1. Contact Information
Name:
Title:
Organization:
Address 1:
Address 2:
City:			State:
Zip Code:			Country:
Phone:			Fax:
Email:

2. Information Systems
Do you have an imaging system?		Yes No
If "yes,"
	What kind of system (manufacturer)?
	Will the images you require be stored on this system?						Yes		No
If "no," are you seeking an alternative storage and retrieval system?							Yes		No

3. Document Specifications
Does this project involve a backfile (archive or active file copies) or file-forward documents (new documents)?
	Backfile		File-Forward
What is the format?
	Microfilm		Microfiche		Aperture Cards
Please indicate the approximate percentage of pages in each of the following categories:
8.5 x 11:		%		Smaller than 8.5 x 11:			%
8.5 x 14:		%		Larger than 8.5 x 14:			%
Please indicate the percentage of images that are 1-up and 2-up:
1-up: % 2-up: %
What is the reduction ratio of the images on the film?
Microfilm: Microfiche: Aperture Cards:
How are these records organized?
	In file folders		Multi-page documents		Individual pages		Other
Please indicate the total number in each category
	Per Day		Per Week		Per Month		Per year		Total Project
	Fiche cards			Fiche frames
	Rolls			Frames
What is the average number of frames per document page?
For cards with frames, how many rows are there per card?
Please describe the average condition of the images.
	Excellent		Good		Fair		Poor
Comments:
Do any of the images include photographs?
	Yes		No
Comments:
Is gray scale required?
	Yes		No
Comments:
Do you use blips?
	Yes		No
What document preparation is required? (Staple-removal, unbinding, etc.)?
What post-production is required? (Purging of images, reassembly, etc.)?
What order are the documents currently in (alphabetical, ID number, Date, etc.)?
	Can the scanned images be in the same order?						Yes		No
	If re-ordering is required, please describe:

4. Indexing Requirements
Number of fields:
Number of characters:
Indexing level:					Page level		Document Level		File Level
Where is the index information located on the documents?
Are there existing computer databases containing the index information?
	Yes		No
Describe database
Index File Layout:
Field Name							Type (Alpha, Numeric, Both)		Size

5. Project Specifications
What is the desired time frame (turnaround) for this work:
How long may documents be out of the file for processing?
Preferred Implementation
	Our facility using our existing equipment
	Our facility using IPS equipment
	Outsourced to IPS; data and image files returned to us
	ImageServ: outsourced to IPS prepping, scanning, indexing and hosting
	Don't know
Is OCR or Full Text searching a requirement?				Yes		No		Don't know
Describe:
What is the desired scanning resolution?				200 dpi			300 dpi			Don't know
What is the output file fo rmat?
What are the burning-to-optical, CD-ROM, DVD or other media requirements?
How many copies of the media do you require?