1375 S. Eastwood Dr. Woodstock, Illinois 60098 Phone: 815-338-0549 Fax: 815-338-0567

Residential Wireless Availability Request

A signal quality pretest must be done at this location to verify that a reliable signal
can be received. To place a free, no obligation order to have this pretest done,
complete the form below. You will be e-mailed the results of your pretest, at which
time you may continue with your order, or cancel.

Note: Fields in bold are required.

Yes, I am interested in wireless Internet solutions from Stan's Internet

First Name:

Last Name:

Company:

Address 1:

Address 2:

City:

Zip code:

Directions:
To ensure prompt arrival for your pretest, please give directions to the location above from a central landmark or crossroad.

Phone Number: (999-999-9999)

Alternate Phone Number: (999-999-9999)

E-Mail Address:

Current Internet Service:

How Did You Hear About Stan's Wireless?

Comments:

Note: Clicking the submit button below will submit your order for a free
wireless pretest. Please click it only once. If you have already submitted an order and wish to make corrections to it, please do NOT place another order. Please call Stan's at 815-338-0549.