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FIRST NAME

LAST NAME

EMAIL

PHONE

STREET ADDRESS

CITY

STATE

ZIP CODE

TO WHICH CITY IS THE EQUIPMENT CLOSEST? (We only cover areas within 45 minutes of these cities)

EQUIPMENT LOCATION - SAME AS BILLING ADDRESS?

Yes

No

TYPE OF EQUIPMENT TO BE REMOVED

NUMBER OF ITEMS TO BE REMOVED (DISHES, ANTENNAS)

SIZE OF DISH OR ANTENNA (Select all that apply)

2 - 4 feet

5 - 10 feet

10 - 15 feet

Larger than 15 feet across

EQUIPMENT HEIGHT (Select all that apply)

0 - 10 feet

10 - 20 feet

20 - 30 feet

Over 30 feet high

FILE UPLOAD (Please submit photos for a more accurate quote.)

Please upload pictures of the equipment, with a view from the ground up to the top of the equipment, and closeups of the base and bracketing. NOT REQUIRED FOR SMALL ANTENNAS OR DISHES.

COMMENT (Do you have anything else to add?)