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TELECOM NETWORK, INC.
SHARED REPEATER FINDER'S FEE CLAIM FORM
1-800-494-3090 Fax: 205-595-7642

FINDER:

COMPANY NAME:
ADDRESS:
CITY ST ZIP
ATTENTION:
PHONE:

NEW CUSTOMER INFORMATION

COMPANY NAME:
CUSTOMER CONTACT:
ADDRESS:
CITY ST ZIP
PHONE:

NUMBER OF UNITS TO BE INSTALLED/BILLED ___________ X $30.00 = ___________________

REPEATER NUMBER RPTR LOCATION
RADIOS WILL BE IN SERVICE EFFECTIVE:

SERIAL NUMBERS

     
     
     
     
     
FINDERS SIGNATURE DATE

PLEASE ALLOW 60 DAYS FOR PAYMENT

RETURN THIS FORM TO:
TELECOM NETWORK, INC.
4116 First Avenue, North
Birmingham, AL 35222

IN ORDER TO QUALIFY FOR THE FINDERS FEE, ATTACH A COMPLETED AND SIGNED COPY OF THE SHARED REPEATER USER AGREEMENT. A CHECK FOR THE HOOK-UP FEE OF ($175.00) MUST ACCOMPANY NEW ACCOUNTS. SHOULD A NEW CUSTOMER REMAIN ON THE SYSTEM FOR LESS THAN SIX (6) MONTHS, FINDERS FEE WILL BE PRORATED.