REFERRALINFORMATION
Name _____________________________ 
Address _____________________________ 
City _____________________________
State _____________________________
ZIP _____________________________
Phone _____________________________
EMail _____________________________
 

REFERRED BY
Name _____________________________
Address _____________________________
City _____________________________
State _____________________________
ZIP _____________________________
Phone _____________________________
EMail _____________________________


To obtain Referral amount -
Customer needs to be receive their service from Clark Electric Appliance & Satellite.
Referred friend must also receive their service from Clark Electric Appliance & Satellite.

MAIL TO:

Clark Electric Appliance and Satellite Inc.
ATTN: WildBlue Referral Offer
PO Box 220
Greenwood , WI 54437