New Xyicon Project Request Form
Project Name
*
Example: Murietta Surgery Center
Address of Project
Street Address
*
City
*
Zip Code
*
State
*
IT Project Manager
This will be the name listed on the quote
First Name
*
Last Name
*
Email
*
Phone Number
*
Project Coordinator
First Name
Last Name
Email
Phone Number
Project Details
Region
*
Select one...
CO
GA
HI
MAS
NCAL
NW
SCAL
WA
Service Area
*
Project Type
*
Select one...
New Construction
Remodel
Xyicon Service Type
*
License and Services
License Only
Building Details
*
If your project is limited to a portion of a building, please list the square footage relevant to the project.
1
+
Estimated Design Start Date
*
Estimated Go Live Date
*
If your project is multi-phased, please list the design start date of the first phase and the estimated go live date of the final phase.
Please Enter the Email Address for Project Team Members (If Known)
ARPM
Design SME (NIDC)
ITC
ICE
Who is Your Architect?
The contact details are informational only. The architect will NOT be contacted without the permission of the IT Project Manager.
First Name
Last Name
Email
Phone Number
What is Your Project's Funding Stage?
*
Select one...
Scoping
Fully Funded
Other Notes
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