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Wireless Site Survey Request
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  *Name:
  *Address:
  Cross Street:
  *City, State:
  *Zip:
  *Phone:
  Alternate Phone:
  email address:
  *Best time to contact me:
  *I'm interested in Castles UltraBand:  Yes
  *I've read and agree to the service agreement:  Yes
  *I agree to allow access to my roof:  Yes
  How did you hear about us?:
  Comments: