1. New Location Form
Complete this form and fax to 817.590.2487.
Please contact support to schedule a Go Live time for location 817.590.2439.
Location cannot be opened until this form is completed & a GO
LIVE is scheduled on support calendar.
*Please be aware, locations will not be taken live on a Friday.*
Loc ID# Date
For Office Use Only
(bold fields are required)
Distributor
Operator *Requested Open Date
Location Name Location Contact
Street Address Location Contact Phone
City, State, Zip Alternate Phone
Distributor Installation
County/Jurisdiction Technician
Location Phone Install Tech Phone
# Units / type
Broadband Provider Subnet Mask
Static IP DNS IP
Gateway IP Secondary
True Live Date Scheduled Install Date
Technician
For Office Use Only
*(mandatory for billing)
Billing Information
Accounts Payable
*Customer Contact
*Guarantor Phone
*Billing Address Fax
*City, State, Zip
*Bill to Email
Customer and Guarantor must match names on the contract
Address cannot be a post office box. Address must be a physical shipping location
Additional Contacts or information
*Contact 1 Contact 2
Title Title
Phone Phone
v100610.1 New Location Form.xls

2. Email Email
v100610.1 New Location Form.xls