ERF Wireless - Wireless Service Request Form

Wireless Service Request Form
In order to receive broadband wireless service you must fill out the form below in its entirety. Once we have your specific information we will schedule your installation at our earliest opportunity. Our wireless dispatch department will contact you with your installation options. We thank your for your interest in our wireless Internet. Basic Installation Pricing: $149.00 Pricing Includes: Up to 2.5 hours of labor Standard Mount (eave or satellite or gable) Up to a 10 ft. mast Up to 60 ft. of cable w/connectors 1 Data Faceplate 1 Wall Drop (Installations with steep roofs or unusual circumstances requiring two men will be priced at $199.00*) Additional home networking equipment to be sold separately. A technician will come to your home and verify signal availability prior to installation. If this is acceptable to you we will need the following information.
Name
Company Name
Address
City
State
Zip
Home Phone
Work Phone
Cell Phone
E-Mail Address
Detailed directions to property for a Site Survey.
Are there tall trees or obstructions around your location? Yes No Not Sure
Do you have an existing TV antenna mast? Yes No Not Sure
Do you have more than one computer that needs to access the Internet? Yes No How Many Computers?
Does your computer(s) have a network card installed? Yes No Not Sure
What type of roof do you have?
Is your roof steeper than an average roof? Yes No Not Sure
If you have more than one PC, are they Networked? Yes No Not Sure
Are you a current ERF Wireless dial-in customer? Yes No
How did you hear about ERF Wireless? Optional
Comments

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