Viasat - Quality Installation
Viasat - Quality Installation
Check this box if you are submitting this form after the installation because you didn't have cell service at the time of installation. (You will need to upload a picture of the signed pre-install/Iron Shield paper agreement.)
Upload paper form
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Attach Files
Installation Type:
New Activation
Service Call
Service Call Details
How was the issue resolved?
Was Equipment Replaced?
Yes
No
ERP Details
Customer Information:
Name
Name
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First
Last
Phone
Phone
*
-
###
-
###
####
Email
*
Account Number
*
Date
Date
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/
MM
/
DD
YYYY
Technician
Technician Name:
Technician Name:
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First
Last
Notes
Customer:
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I am the owner of the property at the address listed on the work order, or I have permission from the landlord/property manager for this installation.
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The technician has shown me how he/she will install the satellite dish and we have agreed upon an appropriate location.
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The technician has shown me how he/she will install cabling including where it will be routed, how it will be attached to the home, and what holes will need to be drilled to bring the cable into the home.
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I have been quoted and will be paying the amount listed below by credit/debit card on file or by check made out to Clear Home for any additional work and/or equipment not covered by my standard installation.
Custom Labor Quote:
$
Dollars
.
Cents
I understand and agree to the entire method of installation as explained to me through the walk through. I understand and authorize the location of where the holes will be drilled, how/where the cable will be routed, dish location, attachments to my home, etc. By signing below I agree to all the terms and conditions of the services lease agreement and everything else as stated above
Customer Signature:
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Draw
or
Type
I understand this is a legal representation of my signature.
Clear
Full Name
I understand this is a legal representation of my signature.
Date
Date
*
/
MM
/
DD
YYYY