Castles Wireless Sign Up Form
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indicates required fields
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First Name:
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Last Name:
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Address:
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City, State:
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Zip:
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Contact Phone:
Alternate Phone:
Billing Name (if different):
Billing Address (if different):
Billing City, State, Zip (if different):
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I accept the Installation & Service Agreement:
Yes
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I agree to a 1 year term:
Yes
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Payment Method:
Please select one
Cash/check
Debit Card
Credit Card
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Invoice Method:
Please select one
US Mail - hard copy
email invoice
Credit Card - no invoice
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Installation Type:
Please select one
Residential
Commercial
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Wireless Option:
Please select one
$69 per month / $249 Installation
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Non-penetrating roof mount (commercial):
Please select one
Yes
Not Applicable
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Add $125 for non-penetrating roof mount:
Please select on
Yes
Not Applicable
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Signature - Person completing this form:
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Checking box acknowledges signing this document:
Yes
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I'm 18 years of age or older:
Yes
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Email Address:
Promotion Code - if applicable:
Comments: