Highspeed Wireless Pre-Qualify

*Pre-Qualify for ISP:
   
* Phone #     <-Do you Exist Already?
* First Name:
* Last Name:
* Address:
Address 2:
* City:
* Province:
* Postal Code:
Email Address:
   
Current Internet Service Provider: (ISP)
   
How did you hear about us:
   
Land Description / GPS Coordinates / (Longitude/Latitude):
* Directions to Home & Description of Property:
Notes:


Worker Safety Involves Everyone!

Please do your part to help our service personel work safely by agreeing to the following:

a) As a responsible adult over the age of 18, you will be on the property at all times during the service appointment.
b) You will either observe the service person or check on him/her every 2 to 3 minutes.
c) You are prepared to call 911 in case of an emergency.
d) You will remove potential hazards, if requested by the service person.
e) You will ensure that all debris, including snow and ice, is cleared from the work area without being asked by our service person.
f) You will secure all animals without being asked by our service person.

Please note that our workers have a legal right to refuse unsafe work. This includes working under certain weather conditions.