This document is a new location form that must be completed and submitted before a new location can be opened. It requests information such as the location ID number, distributor, operator, location name, address, contact details, broadband provider details, billing information, and additional contacts. Locations will not be taken live on Fridays and a go live must be scheduled on the support calendar after submitting the completed form.

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