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

2. Information Systems
For the source of the images:
	System:
	Hardware:
	Software:
	Application:
	Database:
	Operating System:
	Optical Media (Size, Capacity, Brand, Model):
For the desired target of the images:
	System:
	Hardware:
	Software:
	Application:
	Database:
	Operating System:
	Optical Media (Size, Capacity, Brand, Model):

3. Document Specifications
What is the file format of the source images?
What is the desired file format for the converted images?
What is the average size of the images (Kb)?
What is the total size of the image files (Gb)?
How many total optical media (Optical Disks, CDs, DVDs, etc.) will be provided to IPS?
How are the original records organized?
	In folders		Multi-page documents		Individual pages		Other
For the original documents, please indicate the approximate total number for the project
Folders				Documents			Individual Pages
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:
If there are special requirements for corruption or compression errors identified in the images during conversion, please indicate:

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 format?
What are the burning-to-optical, CD-ROM, DVD or other media requirements?
How many copies of the media do you require?