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Equipment Distribution Request Questionnaire

Thank you for your interest in receiving the Pentagon Channel. It's simple and easy. You just need you to fill out the form below. This will supply us with the necessary information to get you the equipment needed to begin providing your base, camp or station the Pentagon Channel. We will contact you if we need more information or to inform you the equipment has been shipped. If you have additional questions just call us toll free at 866-854-3804 or e-mail us at [email protected].

Base Camp or Station:

 

Service/Guard:

 

City:

 

State:

 

ZIP code:

 

POC:

 

POC Phone #:

 

POC E-mail:

 

Shipping Address:

 

DODAAC/UIC:

 

CAC:

  

On-base Provider:

 

Off-base Provider:

 

Equipment Requested:

 

On-base Population:

 

Military:

 

Civilian Government:

 

Family Members:

 

On-base Cable Subscribers:

 

Off-base Cable Subscribers:

 

Comments:


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