Name: 
		Mr.Ms.Mrs. 
	Title: 
	Company: 

	Address: 
	Address: 
	City, State, Zip: 

	Email address: 
	Phone Number: 
	FAX Number: 

We would like to know your current filing system

1. The documents you desire to capture are currently referred to within your organization as (i.e. "Signature files", "Contracts", "Personal Records", etc.):

2. What department is in charge of these documents?

3. For questions we should contact: Mr. Ms.Mrs.

Title:

4. What is the typical size of the pages to be captured? If different sizes, what percentage of each?

8 1/2" x 11": 0% 1%-10% 11%-20% 21%-30% 31%-40% 41%-50% 50%-60% 61%-70% 71%-80% 81%-90% 91%-100%

8 1/2" x 14": 0% 1%-10% 11%-20% 21%-30% 31%-40% 41%-50% 50%-60% 61%-70% 71%-80% 81%-90% 91%-100%

14" x 17": 0% 1%-10% 11%-20% 21%-30% 31%-40% 41%-50% 50%-60% 61%-70% 71%-80% 81%-90% 91%-100%

Other large documents(i.e. Engineering docs, etc.): 0% 1%-10% 11%-20% 21%-30% 31%-40% 41%-50% 50%-60% 61%-70% 71%-80% 81%-90% 91%-100%

Other small documents(i.e. checks, stubs, etc.): 0% 1%-10% 11%-20% 21%-30% 31%-40% 41%-50% 50%-60% 61%-70% 71%-80% 81%-90% 91%-100%

5. What is the approximate percentage of duplex (print on both sides) pages? 0% 1%-10% 11%-20% 21%-30% 31%-40% 41%-50% 50%-60% 61%-70% 71%-80% 81%-90% 91%-100%

6. Please describe in your own words how the documents are currently structured. For example: "multipage folder containing...in...order...indexed by...", etc.

7. The documents are stored as follows (if necessary, measure it in terms of linear feet, storage boxes, etc.)

Paper: Pages Linear Feet Storage Boxes Drawers Filing Cabinets

Microfilm: Pages Linear Feet Storage Boxes Drawers Filing Cabinets

Other: Pages Linear Feet Storage Boxes Drawers Filing Cabinets

8. The estimated average number of pages per folder (document) is: Pages.

9. If color images are required in color, please enter estimated percentage of total: 0% 1%-10% 11%-20% 21%-30% 31%-40% 41%-50% 50%-60% 61%-70% 71%-80% 81%-90% 91%-100%.

10. If photographs are required in grayscare (photomode, fair quality), please enter estimated percentage of total: 0% 1%-10% 11%-20% 21%-30% 31%-40% 41%-50% 50%-60% 61%-70% 71%-80% 81%-90% 91%-100%.

11. Special Handeling:

Do documents need to be restapled? No Yes

Restore exact original stapling device (staple, clip, rubber band, etc)? No Yes

Will some documents be marked "Not to be scanned" but require restoration in original sequence? No Yes

Will some pages be marked "Not to be scanned" but require restoration in original sequence? No Yes

Now lets talk about Electronic Filing

1. Typically, a number of documents must be readily available for fast retrieval. This is referred to as the "on-line segment". It may be measured in number of pages, or in terms of last 'n' months or years of capture.

Estimated size of the on-line segment: Pages Months of Capture Years of Capture

2. Please estimate the number of networked users likely to be accessing these electronic records at the same time:

3. An "index field" is any data related to a document, that might be possibly used in the future to help retrieve taht document. Please indicate which fields you would like to use for this purpose:

Approximate lengths (in characters/digits) of main index fields:

Index Name1: Length: characters/digits.

Index Name2: Length: characters/digits.

Index Name3: Length: characters/digits.

Index Name4: Length: characters/digits.

Index Name5: Length: characters/digits.

Index Name6: Length: characters/digits.

4. Please explain the degree of difficulty in locating the above indexes off your documents, i.e. "easy, always on first page", "easy, on folder's label", "tricky, it may be anywhere on the document", etc.:

5. Average number of new (ongoing) pages to be captured:

Daily:

Monthly:

Yearly:

Approximate yearly growth rate: %

6. What is your best estimate of retrieval requests per day for visual (on-screen) inspection only, no hard copies?

Screen requests per day.

7. What is your best estimate of retrieval requests per day for hard copy reproduction (typically on laser printers)?

Hardcopy requests per day.

8. Is there a database available anywhere in your organization that may contain some or all the indexes to be used for these documents? Yes No

9. The budget for the project has been approved? Yes No

10. You expect to start the project in about Months.