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Your Information for Roblin Tech Services
Please enter your contact information below. This information is being collected by Roblin Tech Services, and will be shared with the service provider should you sign up for service.
* Indicates required question
Full Name
*
Enter the name of the primary contact for this account:
Your answer
Address / Location
*
Enter the physical address for installation (street address, civic address, land location, GPS location):
Your answer
Mailing Address
Enter your mailing address (box number, rural route), or leave blank if the same as above:
Your answer
City / Town, Province
*
Enter your town and province:
Your answer
Postal Code
*
Enter your postal code:
Your answer
Phone Number
*
Enter your primary contact number:
Your answer
Additional Contact Number
Enter any additional contact numbers to reach you regarding the installation:
Your answer
Email Address
Enter your email address:
Your answer
Date of Birth
*
Enter the date of birth of the account holder, this is a requirement from the service provider to create a new account:
MM
/
DD
/
YYYY
Credit Check
*
Please answer yes if you authorize us to do a soft credit check. This does not affect your credit score and is only used to determine eligibility for new accounts and promotions. An upfront deposit may be required if you decline the credit check.
Yes - I consent to a soft credit check.
No - Do not process a credit check.
What Services Are You Interested In
Select ALL that apply:
Shaw Direct TV Service
Xplornet Internet Service
Xplornet Home Phone Service (Internet is Required)
Xplornet Whole Home WiFi (Internet is Required)
Cell Phone Booster and Installation
Other:
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