Site Assessment Form

The information you provide will help us to determine whether we can provide our Rural High Speed at your location.

All fields marked with * are required.

Name: *

Street address: *

City or town: *

Postal code: *

Telephone: *

Email: *

Preferred contact method: *

Telephone

Email

Do you know your GPS coordinates?

If you know your property's GPS coordinates, enter them here. If not, find the latitude and longitude for your address by clicking on this link, or leave these fields blank and we'll find them for you.

Latitude:

Longitude:

Description of location:

Directions to your house from main road.

Description of surrounding vegetation:

Please describe any surrounding trees, estimating how high they are, and which sides of the house they are on.

TV antenna tower

Is there a TV antenna tower on your house?

TV antenna tower: *

Yes

No

TV tower height:

If there is a TV tower, how high is it?

Roof type: *

Asphalt shingles

Steel

Other

House type: *

One-storey

Two-storey

Bungalow

Elevated bungalow

Other

Other structures

Are there any garages or other structures close by?

Other structures: *

Yes

No

Nearby structures:

If there are structures nearby, what are they?

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