Contact

Wireless Site visit request form.

Please complete as much of the information below as possible.

First Name
Last Name
911 Address
Nearest Crossroad
Town
Province
Postal Code
Phone Number
Alternate Phone Number
Your current Email address.

Our location that you think is in range:

Can you confirm you have radio line of sight to tower?: No Yes

Is there a TV Tower near the House: No Yes
House style:
Outside Wall construction: (closest match)
Roof style: (closest match)
Basement Ceiling Type:

Wanting:
Service wanted:

Check here to confirm that you have the homeowner's permission to mount
an antenna as will be discussed with the installer to the house or TV tower.

Any additional comments. Such as best time of day to call, what day of week you prefer for site visit, etc:

revised 2005/02/20