GWI Username (if applicable):

Company Name:

Company Address:

City/State/Zip:

Contact Name (for questions related to this application):

Email Address:

Phone Number:

Number of Key Cards Required:
(Note: One Key Card is included, additional cards cost $10 each)

Requested Installation Date (mm/dd/yy):

24-HOUR EMERGENCY CONTACT INFORMATION:

Contact Name:

Email Address:

Phone Number:

Pager/Beeper Number(s):

BILLING INFORMATION:

Company Name:

Company Address:

City/State/Zip:

Contact Name (for billing only):

PHYSICAL INFORMATION:

Will you be installing server in existing GWI rack: Yes No

If yes, how many Rack Units? 8U 12U 16U 20U 24U 28U 32U 36U 40U

If no, please provide the following information regarding the rack you intend to use:

a. Footprint of rack, in inches:

b. Height of rack, in inches:

c. Locked enclosure? Yes No

Please List NEMA codes (see list below) for all electrical outlets required, if other than a single 125V 15A 1-15R: (Note: Additional fees may apply, we will quote once we receive this application)

Please list any additional facilities required and not listed in our standard co-location package description:

INVENTORY INFORMATION:

Please list all equipment being installed.

Please indication all aspects of equipment specifications, as in the example below, and as generally available from the manufacturer. At a minimum, please include all power characteristics, weight, dimensions, and BTU/hr. Please list for all equipment being installed including servers, switches, hubs, UPS and any other.  Please list in order or top to bottom rack placement.

NEMA Code List:

The following is a list of acceptable NEMA codes. For more information on these codes, including outlet diagrams, please review the attached (this file is in PDF format and is best viewed in Adobe Acrobat Reader. If you need to download this program, please visit the Adobe website.

NEMA Codes: 1-15R, 2-20R, 2-30R, 5-15R, 5-20R, 5-30R, 5-50R, 6-15R, 6-20R,
6-30R, 6-50R, L1-15R, L2-20R, L5-15R, L5-20R, L5-30R, L5-50R, L5-60R,
L6-15R, L6-20R, L6-30R, L6-50R, L6-60R, L10-20R, L10-30R

Example of Equipment Inventory List:

VA Linux 501:
1. Power Characteristics:
        Power Supply: One (1)
        400W Auto-sensing internal power supply
        Voltage: 90-132, 180-264AC
        AC Frequency: 47-63 Hz
        Power Factor: 0.7
2. Dimensions:
        Height: 3.5" (8.9cm)
        Width: 19" (48.26cm)
        Depth: 23.5" (59.69cm)
3. Weight:
        Minimum: 25 lbs (11.36Kg)
        Maximum: 35 lbs (15.9Kg)
4. Environmental Characteristics:
        Efficiency = 70% typical 400W total
        Supply total dissipation: 280W
        BTU/hr = 952 BTU/hr
        AC load in tons = 0.2713 tons