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Date

Name *

First

Last

Email *

Alt Contact *

Phone *

Alternative Phone # *

Referred By:

Friend, Neighbor, Existing Customer Referral

Do you own or rent? *

If renting, you must obtain a letter of permission for us to be on the property to do an estimate or install your service.

Mailing Address *

Address Line 1

City

State

Zip Code

Physical Address *

Address Line 1

City

State

Zip Code

Internet - Residential*

*All prices subject to change & do not include installation, taxes or applicable fees.

Telephone Services - Residential*

*All prices subject to change & do not include installation, taxes or applicable fees.

Internet - Business*

*All prices subject to change & do not include installation, taxes or applicable fees.

Telephone Services - Business*

*All prices subject to change & do not include installation, taxes or applicable fees.

Comment or Message

1. Are there any animals on the property that we need'to be aware of? *

2. Is there any equipment outside that can't be reached without encroaching on the neighbor's property? *

3. Is there any landscaping that must be removed prior to construction? *

4. Are there any unsafe or unsanitary areas on or near the location? *

5. Are there any locked gates or fences that we must have access to? *

Checkboxes

All prices subject to change & do not include installation, taxes or applicable fees.
Kit Carson Internet bill is not included with electric bill.
By submitting this application, customer is allowing KCI to enter property for estimate.

Email *