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CCTV Data Collection Form
"
*
" indicates required fields
1
Customer
2
DVR/NVR
3
ISP
4
Router
5
Network
6
WiFi
7
DDNS
8
Firewall
9
Remote Application
10
WattBox
11
Device(s)
12
Notes & Attachments
13
Authorization
Information I need:
*
DVR/NVR
ISP
Router
Network
WiFi
DDNS
Firewall
Remote Application
WattBox
Device
CUSTOMER & SITE INFORMATION
Martin Account #:
*
Customer Name:
*
Customer Address:
*
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP
IT Contact Name:
IT Phone #:
DVR/NVR INFORMATION
Make & Model:
*
Location:
*
Software Version:
Firmware Version:
Camera License(s):
Operating System Information
OS Type:
Storage Size:
Username:
Password:
NIC 1 Information
IP/Mac Address:
Subnet Mask:
Default Gateway:
DNS Server 1:
DNS Server 2:
NIC 2 Information
IP/Mac Address:
Subnet Mask:
Default Gateway:
DNS Server 1:
DNS Server 2:
Martin Service & Customer User Information
Martin Username:
*
Martin Password:
*
Customer Username:
Customer Password:
ISP INFORMATION
ISP Provider:
ISP Phone #
Dynamic/Static Service
Dynamic
Static
Customer ISP Account #:
Cust. Phone # On File @ ISP:
Martin ISP Username:
Martin ISP Password:
Martin ISP Security Question:
Martin ISP Security Answer
ROUTER INFORMATION
Make & Model:
LAN IP Address:
Outside/WAN IP Address:
Outside/WAN Access Port(s):
Location:
Username:
Password:
NETWORK INFORMATION
IP Scheme:
DHCP Range:
Domain Name:
WiFi Information
WiFi Name (SSID):
WiFi Password:
WiFi Security
DDNS INFORMATION
DDNS Service:
DDNS Website:
DDNS Username:
DDNS Password:
FIREWALL INFORMATION
Make & Model:
Location:
LAN IP Address:
WAN IP Address:
WAN Access Port:
Username:
Password:
REMOTE APPLICATION INFORMATION
Application:
Device Types:
Remote Ports:
WATTBOX INFORMATION
Username:
Password:
Port(s)
DDNS Name:
DEVICE INFORMATION
How Many Devices?
Select
1
2
3
4
5
6
7
8
9
10
Bulk - Large Projects - Cut & Paste
No Cut & Paste
Cut & Paste - Large Projects
Large Projects - Cut & Paste Bulk Devices
Device 1
Device Type:
Location:
Make:
Model:
IP / MAC Address:
Port:
Serial #/QR - Put N/A if not Dahua box:
*
Username:
Password:
Device 2
Device Type:
Location:
Make:
Model:
IP / MAC Address:
Port:
Serial #/QR - Put N/A if not Dahua box:
*
Username:
Password:
Device 3
Device Type:
Location:
Make:
Model:
IP / MAC Address:
Port:
Serial #/QR - Put N/A if not Dahua box:
*
Username:
Password:
Device 4
Device Type:
Location:
Make:
Model:
IP / MAC Address:
Port:
Serial #/QR - Put N/A if not Dahua box:
*
Username:
Password:
Device 5
Device Type:
Location:
Make:
Model:
IP / MAC Address:
Port:
Serial #/QR - Put N/A if not Dahua box:
*
Username:
Password:
Device 6
Device Type:
Location:
Make:
Model:
IP / MAC Address:
Port:
Serial #/QR - Put N/A if not Dahua box:
*
Username:
Password:
Device 7
Device Type:
Location:
Make:
Model:
IP / MAC Address:
Port:
Serial #/QR - Put N/A if not Dahua box:
*
Username:
Password:
Device 8
Device Type:
Location:
Make:
Model:
IP / MAC Address:
Port:
Serial #/QR - Put N/A if not Dahua box:
*
Username:
Password:
Device 9
Device Type:
Location:
Make:
Model:
IP / MAC Address:
Port:
Serial #/QR - Put N/A if not Dahua box:
*
Username:
Password:
Device 10
Device Type:
Location:
Make:
Model:
IP / MAC Address:
Port:
Serial #/QR - Put N/A if not Dahua box:
*
Username:
Password:
Notes
Notes:
Attachments
Attachments:
Drop files here or
Select files
Accepted file types: jpg, png, pdf, doc, docx, xlsx, csv, txt, xls, Max. file size: 15 MB, Max. files: 3.
TECH AUTHORIZATION
Your Name
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A - Select
A: JOB
A: N/A - No Additions
Abrien Coleman
Actual - Egg Harbor
Actual - Green Bay
Actual - Madison
Actual - Milwaukee
Actual - Oshkosh
Andrew Johnson
Andrew Wauters
Anna Mae Schweitzer
Arthur Ruffin
Austin Manecke
Ben Lerner
Blake Robertson
Brad Ohnesorge
Breanna Krueger
Brett Nommensen
Brett Welborn
Bryan Vanbeek
Carter Davenport
Chris Marto
Christen Austad
Christopher Wallace
Collin Steele
Craig Berkan
Dallas Johnson
David Fetter
David Main
David Martinez
Derek Gastorf
Dylan Kitzinger
Dylan McGuire
Eric Olson
Evan Harley
Jackie Rodriguez
Jacob Jansen
Jacob Koehler
Jacob Smith
Jaden Chacon
Jake Neitzel
Jason Karnz
Jeffrey Mayer
Jeffrey Stigler
Jermaine Erwin
Joe Borowski
Joe Hilbert
Johnathan Laurence
Jonathan Martinez
Jordan Yang
Josh Griffin
Josh Pantzlaff
Joyce Byron
Kaden Bonikowske
Kevin Thoman
Kolin Olsen
Koty Francois
Luke Oberstadt
Manny Arias
Marshall Xiong
Matt Ausprung
Maxwell Grebetz
Michael Pekol
Nick Luick
Nick Van Dera
Nicole Smith
Not Listed
Patrick Maxam
Paul Atkinson
Pete Dineen
Reid Hartman
Rey Robinson
Richard Wise
Robert Steffen
Ross Peebles
Sam Kerscher
Sean kramer
Sonia Cleary
T-Dogg
Theodore Maasch
Tim Coyne
TJ Hunt
Trent Taylor
Troy Worm
Warren Mittelstadt
Zac McLees
Zach Smith
Your Initials
*
Email - If your name is not in the list above.
*
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