Technician Referral Form

Employee Information
Employee Name
N/A

Required First Name Required Last Name
Employee UID *
N/A
Employee Email *
N/A
Customer Information
Company Name *
N/A
Customer Name
N/A

First Required Last

Please ensure to identify the correct business decision maker.
Email *
N/A
Phone *
N/A

### ### ####
Number of Locations
N/A
Zip Code
N/A
Business Type *
N/A
Best Time to Contact *
N/A
Does the Customer have a current TV Provider?
N/A
Who is the Customer's current provider?
N/A
The Customer agrees DIRECTV for BUSINESS may contact them by the e-mail and phone number provided. The person giving consent to contact is the same person whose contact information (name, phone number, and e-mail) are on this form. *
N/A
- By checking this box, the technician confirms that the Customer is interested in DIRECTV for BUSINESS products and agrees to be contacted by the e-mail and phone provided. It is a Code of Conduct violation to check this box without Customer consent.
©2024 DIRECTV. DIRECTV and all other DIRECTV marks are trademarks of DIRECTV, LLC. All other marks are the property of their respective owners.

Employee Information