Site Survey Form
Phone: 757-483-3948
Appointment	Date	Time	Map Page/Col/Grid
Approximate time:			Referred by:
Property :	Lease	Association	Own
Customer Name:
Address:
City, State, ZIP
Telephone:
Email:
House Description:
Foundation:	Crawlspace	Slab	Basement
Roof Material
Dish Clearance +/- 3 degrees	Yes	No
Potential Dish obstacles:
Ground source:
Local Reception
Location of 1st Receiver/TV				Model:		Price
Cable Routing:	Attic	Crawl	Wallfish	Outside Wall	Cable/O.D.	Tax
Electrical Outlets	Grounded	Ungrounded	Surge Suppression	Yes	No	Special
Phone Jacks	Existing	Install	Cable Routing	100' +	100' -	Total
Location of 2nd Receiver/TV				Model:		Price
Cable Routing:	Attic	Crawl	Wallfish	Outside Wall	Cable/O.D.	Tax
Electrical Outlets	Grounded	Ungrounded	Surge Suppression	Yes	No	Special
Phone Jacks	Existing	Install	Cable Routing	100' +	100' -	Total
Notes:			Additional Item
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			Additional Item
			Tax
			Additional Labor
			Additional Labor
			Additional Labor
			Additional Labor
			Total
Survey Performed By:				Date:
			Projected Installation Date:
" I have read over the above information and believe it to be as accurate as possible.  I understand that unknown conditions, unaccessable locations,
weather conditions, travel time, and other circumstances may affect pricing, installation time, and labor rates.  Customer will be responsible for any
permits, zoning variances, or covenant exceptions deemed by  local ordanances.  Customer has also been informed of rain fade and potential
future obstructions which may impede the operation of his equipment and accepts this as normal risk.  Customer is responsible for keeping or
discarding all boxes to stay within boundaries of his warranty.  Customer is responsible for filling out all warranty material.  Any modifications to
satellite equipment with out the expressed permission of ComOcean Satellites may void any warranty and require additional charges to correct.
ComOcean Satellites is not responsible for operation or interfacing problems of equipment provided by customer, including EXISTING wiring..
Customer agrees to prices quoted.  Any price changes will be customer approved before additional work is done.  Customer agrees to pay in full
for work after completion unless otherwise noted."
"I have read and agree to the disclosures printed on the back of this sheet"
Customer Signature:				Date: