This form is for customers who wish to register their video conferencing room equipment with ATKSI’s Video Conferencing Center for multi-point videoconferences. You may also use this form to change information on an existing video conferencing site  profile or to delete a video conferencing site from our records.

Select the Appropriate Action:

How your users normally identify this room (i.e., New York, NY, or for more detail — New York, NY., Conf. Rm. 3B)

Endpoint/Site ID: (Assigned by ATKSI)

Street, City, State, Zip:

Mailing address for Primary Contact for Video Services.

Telephone and Fax:

Telephone number and Fax number for Primary Contact for Video Services.

Internet address for Primary Contact for Video Services.

Provide Parent company name, if different from Company room name.

Provide if different than room information.

Check applicable provider. (If unsure, leave blank.)

Transmission Speeds to Be Certified:

Check all transmission speeds to be certified. (If unsure, leave blank.)

Video System Dial-Up Numbers:

Dial-up video number(s) assigned to your video equipment.

Phone Number in Video Room:

Voice telephone number in your video room.

Brand name of video system (i.e., PictureTel).

Equipment Model:

Equipment model description (i.e., 3000 or 4000EX).

Software Version:

Software version for your equipment.

Manufacturer, model, and software version.

Your company’s legal corporate name or any other name by which your company is registered (i.e., acronym).

Attention to:

Individual/department responsible for remittance.

Billing Contact Name:

Name of the individual/department responsible for remittance.

Telephone number and Fax number of billing contact.

Mailing address for Billing contact.

If you are an existing video customer with ATKSI’s Video Conferencing Center check if the video site, your are currently registering, should be included on an existing bill. Provide the existing bill number or an existing 7-digit video site ID assigned to the account.