*Project Name: Date: State     *Company Name *Name

Phone # Fax # *E-Mail

RF Outputs System Inputs: Total TV locations Outputs @ 1-100' Outputs @ 100-200' Outputs @ 200-300' Outputs over 300' Antenna                   HDTV            Cable                      Digital Cable   Cable Modem   Number Boxes Total Modulated Sources (Please indicate the # of internal and external modulated inputs) # Mods-Internal # Mods-External # of Coax from Panel to each TV # of coax from Dish Location to Panel   Other

System Type Number Receivers Distance of Furthest Receiver from Dish DIRECTV® (if DIRECTV® LNB or 5 LNB or 3LNB or Older) Dish Network Other Receivers in a Rack: yes no Application: Residential Commercial

Telephones Number of Lines In Number of Drops 110 Punch or RJ-45         RJ-3/X Security System Connection Panasonic: Yes No Do you want a whole house DSL filter? Yes No Do you want surge protection? Yes No

Telephone Entry System Number Stations Number Strike Releases Camera at Door yes no Modulate Camera yes no Page Out   yes no

Data Number of Locations / Computers Do you want wireless connectivity? Yes No Will you have a access point? Yes No Internet Connection Type: Dial-up Cable DSL Would you like a blank plate to mount the modem inside the panel? yes no

Audio A-Bus® Aria™ Number of Sources: Number of Zones: Power Option 20 w/Channel 60 w/Channel