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
Please Choose One:
Sole Propriertorship
Partnership
Corporation
Limited Liability Company
Other
If you choose other, please explain:
Does your Company carry Liability Insurance?
Yes
No
Do all of your installers have:
Sky Jack Training
Yes
No
Fall Arrest Certification
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:
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:
Hughes VSAT Certification
Spacenet
Mainstream
Viasat
LAN Networking
Installer Experience and Training:
Commercial VSAT Installation/Service
Hughes/HNS VSAT Certification
Spacenet Experience
Commercial DIRECTWAY Experience
VSAT Experience in a Mall (RTS)
DISH Commercial Satellite
DISH MDU Satellite
C-Band Satellite
Multi-Room Audio Systems
Commercial A/V Systems
DSL Broadband
Cable Systems
Cable Broadband
Small Commercial Office
Data Networking
Off-Air UHF/VHF/HDTV
Antennas
Closed Circuit Television Systems
Structured Wiring (Pre-Construction)
Small/Large scale video dist. systems
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
DBS Signal Meter
Cat-5 Tester
Punch Down Tool
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:
