DIRECTV Site Survey
Customer Information
Company Name:
*
Contact Name:
*
Address:
City:
State:
Zip:
Phone:
Fax:
Cell:
Customer #:
Landlord Information
Does Customer own building?
Yes
No
Landlord Company Name:
Landlord Company Contact:
Contact Phone:
Landlord Company Address:
Landlord Company City:
Landlord Company State:
Landlord Company Zip:
Is certificate of insurance required?
Yes
No
Has landlord approved satellite installation?
Yes
No
Building Information
Building Type:
No. of stories:
Roof Structure:
Roof Access?
Yes
No
If Yes, type of access:
Mount Type:
NPRM
Ground
Wall
Penetrating Roof
Cable Type:
RG 6 PVC
RG 6 Plenum
RG 11 PVC
RG 11 Plenum
No, of drops:
Estimated length of cable from antena to receiver:
Estimates length of cable drops:
1:
2:
3:
4:
5:
6:
Phone Lines:
By QCTV or Customer:
Type of Payment:
No. of additional receivers:
Receiver Locations:
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QCTV Toll free: 888.241.7350
salesinquiry@qctv.com
