NAME: Title:  First:  Last:    
     Company: 
  Job Title*: 
     Address: 
    Address*: 
        City:   Postal Code: 
 State/Prov.: 	Country*: 
   Day Phone: 		Fax: 
      E-Mail: 

What business best describes your company/organization?
Telco Carrier                Education
Health Care                  Financial Services
Retail                       State & Local Government
Transportation               Utilities
Manufacturing                Wholesale Trade
Insurance                    Real Estate
Services                     Reseller
Other: 

What is your primary business role?
Accounting/Finance            Administrative
Computer Consulting           Corporate/General Management
Data/TeleCom Management       Education/Training
Engineering                   Information Management
Manufacturing                 Marketing
Operations Management         Network/Communications Management
Purchasing                    Research and Development
Other: 

What products and/or services are you most interested in?
(Please select all that apply)
 Frame Relay                   Fiber Optic
 ATM                           Digital Access
 Remote Dial Access            Network Management
 Professional Services         Network Integration Solutions
 Milgo Product Catalog	  Other: 

How are you currently networking? 

Would you like a Milgo representative to contact you?
	 Yes			 No

Please select any of the following which you will be
implementing during the next year:(Select all that apply)
Remote Access			Network Security
Intranet/Internet		LAN/WAN
Frame Relay			ATM
Network Management		Multimedia Fiber Backbone Network
  Other: 

What is your time frame for implementation? 3-6 months6-9 monthsGreater than 9 monthsLess than 3 months

Please enter any additional plans you have.