JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Antenna Recommendation Sign Up Form
Fill out this form to sign up for an antenna recommendation or antenna consultation. Please allow 1-2 business days for processing not including weekends. Serious inquires only.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Name
Your answer
Full address where antenna will be set up (please include street, town, and state)
Your answer
Please Verify your Town/State
Your answer
Phone number
Your answer
Current Antenna - Do not put "$" in text or it will mess up the total.
Your answer
How many stories is your house/apartment?
Single Story
Two Story
Three Story
Clear selection
How many TV sets are you connecting to the antenna?
Your answer
Please describe the issue with your current antenna if you have one. Any issues receiving specific stations? Please list the channel numbers and call letters when listing specific stations.
Your answer
Preferred Antenna Recommendation
Indoor
Attic
Outdoor
Clear selection
Payment Method
Credit/Debit Card - Follow the checkout link on the next page
PayPal - Follow the checkout link on the next page
Money Order/Check - Wait for email instructions
Clear selection
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
