Samsung GR40 Installation Checklist Dealer Information* or required Indicate Required FieldsDealership Name* Submitter's Name* Submitter's Phone*Submitter's Email Site InformationSite Name* Address* Address 2 City* State / Province / Region* ZIP / Postal Code* Contact Name* Contact Title* Contact Phone*Contact Email X-Ray Room InformationEquipment Manufacturer Model Date of Manufacture MM slash DD slash YYYY Samsung GR40 System InformationSystem Serial No.* Detector Serial No.* Detector Serial No. Software Version* THU Version External MAC Address* Service Tag# Install Date* MM slash DD slash YYYY First Clinical Use* MM slash DD slash YYYY DICOM & Network InformationStation Name AE Title IP Address Subnet Mask Gateway DNS Internal WIFI InformationWIFI Name WIFI Password Channel Signal Strength at Wall Signal Stregnth at Table Does Channel Have Traffic? Yes No List Names of Channel Traffic Exposure DelayExposure Delay Form NotificationEnter the email address for the person who should receive this formEmail Confirmation* Enter Email Confirm Email Email Confirmation 2 Enter Email Confirm Email Email Confirmation 3 Enter Email Confirm Email Δ