Castles Wireless Sign Up Form
* indicates required fields 
  *First Name:
  *Last Name:
  *Address:
  *City, State:
  *Zip:
  *Contact Phone:
  Alternate Phone:
  Billing Name (if different):
  Billing Address (if different):
  Billing City, State, Zip (if different):
  *I accept the Installation & Service Agreement:  Yes
  *I agree to a 1 year term:  Yes
  *Payment Method:
  *Invoice Method:
  *Installation Type:
  *Wireless Option:
  *Non-penetrating roof mount (commercial):
  *Add $125 for non-penetrating roof mount:
  *Signature - Person completing this form:
  *Checking box acknowledges signing this document:  Yes
  *I'm 18 years of age or older:  Yes
  *Email Address:
  Promotion Code - if applicable:
  Comments: