Please fill in this form completely and click the 'submit' button when finished.
All fields marked with a * are mandatory.
 
Date:
Business Information
Full Legal Name of Company:
* Business address
* Primary Contact: Title:
Secondary Contact: Title:
* Main Phone Number: Alternate Phone Number:
Cell Phone: Fax Number:
Pager Number: Web Address:
* E-Mail Address:
Organization of Business
If you choose other, please explain:
Does your Company carry Liability Insurance?  Yes            No
Tell us about your Company:
Number of Employees: Number of Trucks:
Number of Technicians: Business Hours:
Territories
List the Cities in which your perform installation services:
Experience and Qualifications
How many years in business: How many years in installation:
Number of installers: Full Time: Hourly Rate:
Part Time:
Total Number of installations completed per month by your company:
Check all of the following categories for which industry certification has been obtained:
LAN Networking      
 
Installer Experience and Training:
 Commercial VSAT Installation/Service  Commercial DIRECTWAY Experience
 Residential Satellite  DISH Commercial Satellite
 Hardline Cable Experience  C-Band Satellite
 DISH MDU Satellite  Commercial A/V Systems
 Multi-Room Audio Systems  Cable Systems / Distribution
 DSL Broadband  Small Commercial Office
 Cable Broadband  Off-Air UHF/VHF/HDTV
 Data Networking  Closed Circuit Television Systems
 Antennas  Small/Large scale video dist. systems
 Structured Wiring (Pre-Construction)  Headend Experience
 Hughes/HNS VSAT Certification  
Describe Relevant Work Experience: (Commercial VSAT, Digital Media, Military Experience, provide dates, locations etc.)
Basic Installation & Test Equipment Available
 Ladder (Height: )  Spectrum Analyzer
 Birdog Satellite Meter  Laptop (w/ ethernet)
 Digital Camera  Voltage Meter
 Analog RF Signal Meter  Cat-5 Tester
 Digital RF Signal Meter  Fish tape
 Telephone Line Tester  Inclinometer
 RS 232 Cable - straight through  Crimper (cat-5 4-pair)
 Compass  Compression crimpers
Any additional information or experience that may be relevant: