Service Agent Questionnaire
Company Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name of Primary Contact
First Name
Last Name
Primary Contact Title
Email
example@example.com
Phone Number
-
Area Code
Phone Number
After Hours / Emergency Service Contact Number
-
Area Code
Phone Number
1. Service Area
Travel radius in miles and/or hours, or nearby cities
Additional Comments
2. Hours of Operation and Rates
Monday thru Friday (Hourly Rate)
After Hours/Weekends/Holidays (Hourly Rate)
Expedited/Emergency Service (Fee/Hourly Rate)
Do you charge travel time, truck roll or a dispatch fee? If so, what are the rate and terms?
Additional Comments
3. Work Experience
How many years experience to you have for the following:
DIRECTV Commercial
Off-the-air Systems
Distribution Systems
DTV DRE Systems
DTV D2 (MFH Systems)
Dish Network QAM Systems
Video Propulstion Floodgate Systems
HD Systems
SD Systems
Fiber Optic Distribution
Internet/Cat5 Cable/Networking
Dish Network Commercial
Technicolor/Thomson Com1000/2000 Systems
TV Channel Mapping/Programming/Cloning
Additional Comments
4. System Repair Services
Please check the systems and services you are willing to provide.
I DO NOT wish to perform any repair services
DIRECTV Commercial
Off-the-air System
Distribution System
DTV DRE System
DTV D2 (MFH) System
Dish Network QAM System
Video Propulstion Floodgate Based System
HD System
SD System
Fiber System
Internet/Cat5 Cable/Networking
Dish Network Commercial
TV Channel Mapping/Programming/Cloning
Technicolor/Thomson Com1000/2000 Based System
Additional Comments
5. Installation Services
Please check the systems and services you are willing to install.
I DO NOT wish to perform any installation services
DIRECTV Commercial
Off-the-air System
Distribution System
DTV DRE System
DTV D2 (MFH) System
Dish Network QAM System
Video Propulstion Floodgate Based System
HD System
SD System
Fiber System
Internet/Cat5 Cable/Networking
Dish Network Commercial
TV Channel Mapping/Programming/Cloning
Technicolor/Thomson Com1000/2000 Based System
6. Test Equipment
Do you and/or your techs have and know how to operate the following test equipment?
Fiber Optic Meter
Satelite Meter (Super Buddy or equivalent)
DIRECTV AIM Meter
Digital Field Strength Meter (Sadelco or equivalent)
Spectrum Analyzer
DVM
TDR
7. Certifications
List any industry certifications or specialty training you and/or your technicians currently holds i.e. (SMATV / MDU / DRE / D2 / Comm1000 etc.)
Additional Comments
8. Representation
Are you presently representing another company as a service or installation agent in the hospitality or healthcare industry that would create a conflict of interest or violate an existing Non Compete or Confidentiality Agreement?
Yes
No
Additional Comments
9. Additional Information
Please provide any additional information, experience, training, certifications etc that you feel would be relevant to the questionnaire.
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