KyWiFi Service Qualification Request

KYWIFI SERVICE QUALIFICATION

PLEASE READ

IT MAY TAKE UP TO 3 - 4 WEEKS DUE TO HEAVY VOLUME. PLEASE DO NOT CALL OR EMAIL FOR STATUS DURING THAT 3 - 4 WEEKS. SHOULD AN ON SITE EVALUATION BE NECESSARY NO APPOINTMENTS WILL BE MADE AND YOU WILL NOT RECEIVE A CALL BEFORE THE TECH ARRIVES. IF AN APPOINTMENT IS REQUESTED THERE WILL BE A CHARGE OF$99.95 PER HOUR.

KyWiFi serves Montgomery and the borders of Bath, Bourbon, Clark, and Nicholas counties only. To see if your location qualifies for service please provide the requested information. Complete this form in its entirety for accurate processing of your request. You may be asked to provide a picture of your location. Service availability, installation cost and speed capacity will be determined in the site evaluation process. You will be contacted by the email provided when the site survey has been completed. No notification by phone will be made. Installation will be scheduled on a future date. Notification of the results will be received from survey@kywifi.com to the email address you provided below. Please white list survey@kywifi.com to prevent the response going into the spam folder. Thank you.

Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

County*

Google Map Coordinates - to help with locating please find your property on Google maps and record your coordinates below.

Phone Number*

Area CodePhone Number

Email*

example@example.com

Own or Rent: Renters - Please make sure you have approval.*

Address Visible*

Gate*

Animal Need Restraining*

Structure Type*

Structure Material*

Structure Color*

Directions or Special Instructions

Hard to locate, locked gate, animals, etc.0/25

The Service Qualification Request is a preliminary qualification and is not a guarantee of availability or service.