Are you prepared to pay for initial install fees upon completion of your site survey if TXOL can in fact service you? YES NO

Please do not fill out this form if NO. If YES, please continue. 

Client Type:                            Residential Basic Wireless
                                                 Commercial Basic Wireless
        

Company Name:             
First / Last Name:           
Physical Address:   
Nearest Land Mark:       
(Please enter the nearest landmark in the box above, for
example name of school, hospital, church, locations that
are well known to the community.)

Please give accurate directions to your house or business.
 

City:                             
Postal Zip:                   

We need all phone numbers you can provide as our technicians work out in the field and are not in the office often. The numbers provided will only be used for the purpose of deploying this service.

Daytime Phone:           
Evening Phone:           
Cell phone:                  
Fax number:             
Email Address:            

Number of Computers:  1 Computer 2 Computers 3 Computers 4 Computer More than 4

Computer OS:                 Windows 2000 Windows NT Windows XP Mac OSX Mac OS Windows Me Windows Vista



Additional comments and/or questions