E&E Enterprises Global, Inc. 20 Basil Sawyer Dr., Hampton, VA 23666

Please e-mail this completed/signed form to purchaseorders@eeenterprisesinc.com and

fax a signed copy to 757-265-9750 office 757-826-9532

SITE SURVEY REQUEST

Please complete the following in order for E&E to better serve your needs.

POC Name:  ________________________________________________

                                Person who will coordinate the Installation with E&E Enterprises Global, Inc.  

POC    Address: _______________________________________________

                            Physical Location of the Satellite/equipment installation.           

            City: __________________________________________________

            State: __________

            ZIP: ___________

 POC    Phone numbers: Office __________     Cell: ____________ Fax: ____________

FAQ’s: 
 - What type of building do you have?  _____________________
 - What kind of roof is on the building? Flat, Pitched, Metal, Asphalt

 - Is there a requested type of install? Pole Mount, Wall, Special

 - Do utility lines need to be marked before the install? YES or NO
 - Is there already a P.O.E. for cabling?                         YES or NO
 - Approximately how many feet of cabling will be required to go from the dish location to the modem? _______________ ft.
 - Are there any trees or other obstructions to the south/southwest of the installation site? YES or NO

 - What are your security requirements? ____________________

 -  What are your special requirements if any? ____________________________________________________

I the undersigned certify that the information provided is correct.  I understand that the Site Survey cannot proceed until the Survey Fee of $350.00 has been paid.  I understand that my Site Survey and Installation are provided under the terms of my Quote and Customer Service Agreement located at http://www.eeenterprisesinc.com/agree.htm . For GSA schedule purchases GSA schedule rules and regulations also apply.  I understand that by violating these terms that I will void my warranty and cancellation fees will apply.  Site Survey fees are Non-Refundable.  If you have any questions regarding your site survey or installation please call 1-866-314-5860 or 757-826-9532 and ask for the Installations Management Group/Installation Manager. 

_______________________________                                                ___________________________

Customer Company Name/ Organization                                                                         Date

_________________________________                                              ____________________________

Responsible Party Signature                                                                                              E&E Assigned Site ID