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Wireless Survey Request 

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Please fill out this form to request a site survey. When possible please provide your rural 911 address instead of your Rural Route and Box Number.

After this form has been submitted our survey staff will do an initial survey of your location without first contacting you. If this is a problem, or you wish to be present, please request that we contact you before the initial survey by adding a note in the comments box below. Our staff will not get on your roof or climb any other structures to check visibility on an unscheduled survey, but they may park in your driveway and walk around a bit to examine your location to look for any trees or other obstructions which may be in the way, and generally examine the area relative to determining signal availability.

Once the initial survey has been completed, our staff will then contact you by phone or email with the results of your survey. Please note that it is possible we may need to schedule a follow up survey to examine your needs in more depth, which may include climbing on top of your roof and/or using test equipment to determine signal availability.


Name:
Address:
City: ** PENDING — see note below.
E-mail Address:
Phone Number:
  ** PENDING — We are currently in final negotiations for tower space to provide wireless service in this area.
Please submit a survey request so that we will know you are interested.

Service Plan Desired:
Residential $39.95/month All service areas EXCEPT Coffey County and Westphalia.
Residential $29.95/month Coffey County and Westphalia ONLY.
Business $59.95/month All service areas EXCEPT Coffey County and Westphalia.
Business $49.95/month Coffey County and Westphalia ONLY.

Installation Options:
Installation - $300.00
A full and complete installation includes standard range radio equipment, mounting and cabling performed by our installer.
Self-Installation Customer uses own equipment and performs installation. Terra World provides the wireless access service only.
Contract Options: NO CONTRACT
Please include a brief description of your location and the surrounding terrain.
Also, add any questions or comments here:
 
Total Installation Fee: $
Total Monthly Fee: $

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