Work Completion Form

Customer Name: _______________________________

Customer Location: _______________________________
_______________________________
_______________________________

Please Check One: _____New Installation _____ Service Call

I understand and agree that a charge may be incurred to my account as a result of the service
call the technician has performed. (if applicable).

At this time NEWco High Speed Internet has successfully installed, uninstalled, or repaired a
high-speed wireless service to my residence or business located at:

____________________________________.

I have personally examined the service and it is working to my satisfaction and as detailed in my
service plan. The NEWco High Speed Wireless installer has directed me to the Terms of
Service located at: http://www.gawhsi.com/tos/

I have read the Terms of Service and hereby agree to the Terms for the duration of my time as a
NEWco High Speed Wireless customer.

Authorized Signature: _______________________________

Print Name: _______________________________
Date: _______________________________

NEWco PO Box 5233 W. Lebanon, NH 03784

877-543-8429
info@gawhsi.com