Name of Video Endpoint or Room Name Company Name Address Contact Name Title Business Phone Cell Phone Email Address Billing Contact Name Billing Phone Number Billing Email Address Technical Contact Name Technical Contact Phone Number Technical Contact Email Address Equipment Manufacturer + Model Software Version (If available) IP Address ISDN Number Type of Conference or Service Required ISDN DID to IP System Multipoint Bridging Desktop Videoconferencing IP/ISDN Gateway Service Recording and Live Streaming 24/7/365 Virtual Meeting Room Unified Conferencing Desktop / H.323 (IP) / H.320 (ISDN) / SIP / POTS (Voice) Other If other please specify