Home » Partner » Referral Program Form Your Information: * Your First Name * Your Last Name Your Email * Your Phone Your Company Name Your Address Your City Your State Your Postal Code Your Comments Information on your referral: * First Name * Last Name Title Email * Phone Number Company Name Address City State Zip * Market –None– Atlanta Austin Baltimore Dallas/Ft Worth Des Moines Ft Lauderdale Houston Las Vegas Los Angeles Miami Orange County Philadelphia Phoenix San Antonio San Diego Washington DC Other * Application –None– Internet Internet + Voice Point To Point Data Carrier Services Other Speed Of Interest(Mb) –None– .35 1 2 3 4 5 6 7 8 9 10 15 20 30 40 45 50 100 155 622 1000 Are you currently working with an Airband sales rep? If so, who? * This offer may not be combined with other promotional offers. To be eligible for the referral fee, the referred prospect must sign a service contract within 90 days of the referral, be a new Airband customer and have paid the first two bills in full.