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Billing, Sales, & Support
  (417) 459-4153
 Request a Site Survey

None of this information will be shared with any third party.

Please Fill In Your Contact Information:
Last Name  
 

First Name

Business Name (If Applicable)
Address for service Phone Number
City                                               Best time to contact
  AM   PM
State
Email address
Zip Code

Please select one answer for each of the following questions:
1. Can you see the tower (View Map)
  Yes
  No
  Not Sure

2. Which equipment ownership option would you prefer?
  Total Wireless retains ownership
  Purchase ($500 per radio)

3. Which installation option would you choose?   (explain)
  Partial Self Install (Subtract $35.00)
  Professional Install (Basic)
  Professional Install (Advanced)

4. What type and level of service are you interested in?
  Residential   Commercial
  256kbit   256kbit
  512kbit   512kbit
  1Mbit   1Mbit
     
5. Type of building service will be installed at? (Renters click here)
  Single-story Home      Town home/Condo
  Two-story Home      Single Story Office Building
  Multi-Story Office Building   Apartment
     

6. Which payment option will you be using to pay for the installation and monthly service?
  Credit/Check/Debit Card                 
     
7. Number of PC's  that will use connection?
  

Additional information:
       
1. Who were you referred by?
Local computer shop (please specify)
PC Outlet in Ozark
Existing Customer (please specify)
Other (please specify)

   Other Specified:
      

2. What is your requested timeframe to have service installed?
  (Install fee and first month service due at time of install)
As soon as possible
Within the next 2 weeks
Within the next month
Just shopping around
Other

   Other:
      

3. Use the space below to describe where in your house your computer is located, what floor, which side, etc., as well as any special installation requirements you may have.
   
       

NOTE:
1) Once you submit this form we will contact you within two(2) business days.
2) Please inform all interested parties of the time and date that we will be performing the site survey/install.
3) We normally prefer to do the install at the same time as the survey when service is available.

In order for us to best assist you, all fields must be completed .
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