Wireless Order Form
Wireless Order Form
Contact Information
Name:
Company:
Contact Phone:
This number is for IAW to call you
Fax:
Email:
FULL Address:
City:
Province:
Postal Code:
Existing Tower:
Yes
No (ie: tv tower or 2 way radio tower)
Number of Stories(building):
We need infomation about the area around your property
ie: High Tree to the west, Barn to the south, etc
"
IAW Subscriber:
Yes
No
Payment Type
VISA
M/C
Pre-Authorized Chequing
If you do NOT fill out this form correctly, it may result in a longer wait for your line to be activated.
