Skip to content
Home
About Us
Insights & Articles
Contact
Home
About Us
Insights & Articles
Contact
Become A Dealer
Location Submissions
Please enable JavaScript in your browser to complete this form.
Please enable JavaScript in your browser to complete this form.
Request Type
*
New Location
Relocation
Full Name
*
First
Last
Contact Number
*
Email
*
Business Name
*
Business Address
*
Address Line 1
Address Line 2
City
--- Select state ---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
This address should be your business address, and not be the submitted site address.
Location Details
Store Address
*
Address Line 1
Address Line 2
City
--- Select state ---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Primary Language Spoken
*
Chinese
English
English/Chinese
English/Korean
English/Spanish
Korean
Spanish
Merchandising Language
*
English
Spanish
English/Spanish
Floor to Ceiling Measurement
*
Minimum ceiling height: 8'6" Maximum ceiling height: 14'
Ceiling Type
*
Drop
Solid
Open
Store Sq. Ft.
*
Available Space Only. If SWAS: please provide dimensions for only the space being used, not the full store it is within.
Attestment to Window Merch Requirements
*
Yes
Site must be able to accommodate a minimum of 2 exterior window posters
High Security Concept Needed?
*
Yes
No
If yes, please provide photos of businesses in the area with this concept in play.
Site Attributes
Site Type
*
In Line
Mall - In Line
Mall - Kiosk
Standalone
Strip Center
SWAS - In Line
SWAS - Kiosk
Kiosk Size Requested
*
5x10
10x10
10x20
Name of Mall
*
Please only enter the name of the mall - ex. Northtowne Mall
Floor Level / Space #
*
Example - Second Floor/ Space #109
Kiosk Size Requested
*
5x10
10x10
10x20
Name of Business Site is Located In
*
Please only list the name of the business - ex. Cardenas
Placement within the Business (for SWAS)
*
Where will the SWAS be located in the store?
Number of Walls (For In Line SWAS)
*
1
2
3
4
If there are NO walls, please change site type to Kiosk rather than In Line.
Banner Needed
*
Yes
No
Banner Size
*
26 x 80
48 x 96
43 x 133
72 x 220
Previous Wireless Location
*
Yes
No
Brand
*
Boost Mobile
Metro by T-Mobile
Cricket
Simple Mobile
Total Wireless
Tracfone
Other
Primary Competitors in the Area
*
Boost
Cricket Wireless
Metro
None
Dominant Tenant Anchor Name
*
Projected Rent
*
Building Facade for Signage
*
Yes
No
Exterior Signage Size Based Upon Facade in Feet
*
Forecasted New Activations Per Month:
*
Additional Comments
**If this site is to replace an exsisting site submission on the funnel, please indicate that and provide the address of the location you would like to swap with.**
Site Pictures | LOI | Agreement
Site Pictures
*
Drag & Drop Files,
Choose Files to Upload
You can upload up to 10 files.
Upload the following pictures in png or jpg formats: Store Front/Exterior | Store Interior | Anchor Tenants | Parking Area Location needs to meet certain criteria so the more pictures submitted the better.
Please ensure that if a kiosk or SWAS concept, photos of the space, as well as a mall map with placement, and surrounding businesses are included.
Consent
*
I agree
By checking the "I agree" box and submitting the form, you consent to receive email and SMS marketing communications and agree to our
Privacy Policy
and
Terms of Use.
Submit