SERVICE TECH QUESTIONNAIRE

SERVICE TECH QUESTIONNAIRE

Please fill out your information below.
Company Name*
Name*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Name of Primary Contact*

First NameMiddle InitialLast Name
Contact Job Title*
Phone Number*

Area CodePhone Number
E-mail*
Service Area(s)
Travel Radius in Miles or Nearby Cities*
Additional Comments
Hours of Operation
Hourly Rate *
Monday-Friday
After Regular Business Hours*
Weekends/Holidays
Emergency or Expedited Fee*
Hourly Rate
Do you charge for travel time, truck roll or a dispatch fee?*
If yes, please explain
Additional Comments
Work Experience

How many years of experience do you have for the following?
DIRECTV Commercial*
No. of Years
Off-the-Air Systems*
No. of Years
DIRECTV DRE Systems*
No. of Years
Distribution Systems *
No. of Years
DIRECTV D2 (MFH Systems)*
No. of Years
Dish Network QAM Systems*
No. of Years
HD Systems*
No. of Years
SD Systems*
No. of Years
Internet/Cat5 Cable/Networking*
No. of Years
DISH Network Commercial*
No. of Years
Technicolor/Com2000 Systems*
No. of Years
TV Channel Mapping/Programming/Cloning*
No. of Years
Additional Comments
System Repair Services

Please check the systems/services you are willing to provide
CHECK ALL THAT APPLY

I do NOT wish to do any repair servicesDIRECTV CommercialOff-the-Air SystemDistribution SystemDTV DRE SystemDTV D2 (MFH) SystemDish Network QAM SystemVideo Population Floodgate Based SystemHD SystemSD SystemFiber SystemInternet/Cat5 Cable/NetworkingDISH Network CommercialTV Channel Mapping/Programming/CloningTechnicolor/Thomson Com2000
Additional Comments
Installation Services
CHECK ALL THAT APPLY

I do NOT wish to do any installation servicesDIRECTV CommercialOff-the-Air SystemDistribution SystemDTV DRE SystemDTV D2 (MFH) SystemDish Network QAM SystemVideo Population Floodgate Based SystemHD SystemSD SystemFiber SystemInternet/Cat5 Cable/NetworkingDISH Network CommercialTV Channel Mapping/Programming/CloningTechnicolor/Thomson Com2000
Test Equipment

Do you and/or any of your techs have and know how to operate the following test equipment?
CHECK ALL THAT APPLY

Fiber Optic MeterSatellite Meter (Super Buddy or equivalent)DIRECTV AIM MeterDigital Field Strength Meter (Sadelco or equivalent)Spectrum AnalyzerDVMTDR
Certifications

List any industry certifications or specialty training by you and/or your technicians
Representation
Are you presently representing another company as a service or installations agent that would create conflict of interest or violate an existing Non-Compete or Confidentiality Agreement?

YesNo
Additional Comments
Additional Information

Please provide any additional information, experience, training, etc. that you feel would be relevant to this questionnaire
Should be Empty:

SERVICE TECH QUESTIONNAIRE

Service Area(s)

Hours of Operation

Work Experience

System Repair Services

Installation Services

Test Equipment

Certifications

Representation

Additional Information