Dish Network Residential Form for the Satellite Center 859-282-2000 Ext. 109

Dish Network Residential Form for The Satellite Center – 859-282-2000 Ext. 109

Place an “X” to select your monthly programming and equipment: Click on the package to link to more information, or visit dishnetwork.com/packages

_____ Smart Pack 55 channels $32.99 _____ Top 120 120 channels $54.99 _____ Top 120 Plus 120 channels + RSN $59.99 _____ Top 200 220+ channels $69.99 _____ Top 250 240+ channels $79.99 _____ HBO Package 9 channels $19.00 _____ Showtime Package 9 channels $14.00 _____ Starz Package 8 channels $14.00 _____ Cinemax Package 5 channels $14.00 _____ Other varies call for pricing

--PRICES AND CHANNELS IN PACKAGES ARE SUBJECT TO CHANGE WITHOUT NOTICE--

Do you want HD programming? _____ Yes – Add’l $10 per month. _____ No

TYPE OF RECEIVER WANTED: ____ VIP211K* $85.00 ($75.00 + $10.00 shipping) -Can only be used on one (1) TV

____ VIP722DVR* $235.00 ($225.00 + $10.00 shipping) -Can be used on two (2) TVs Additional $6.00 per month programming fee. This DVR Receiver works 2 outlets independently.

* Standard residential receivers will not work on this system

NUMBER OF OUTLETS (MAXIMUM OF 2 INDEPENDENT OUTLETS) ______

Information We Need to Set-Up Your Account:

NAME ______

ADDRESS ______

CITY ______STATE ______ZIP______

TELEPHONE NUMBER ______CELL NUMBER ______

SOCIAL SECURITY NUMBER ______(Required to set up account, leave blank to have us call you)

SALES TAX WILL BE ADDED TO ALL PRICES.

STANDARD INSTALLATION CHARGE IS $50.00 FOR UP TO 2 OUTLETS. ADDITIONAL OUTLET 1 INSTALLATION IS $25.00 PER OUTLET. WE WILL CONTACT YOU WITHIN TWO BUSINESS DAYS TO SET UP INSTALLATION. DUE TO EXISTING WIRING, THERE IS ONLY ONE SATELLITE RECEIVER PERMITTED PER UNIT.

AT INSTALLATION, THE INSTALLATION CHARGE, THE RECEIVER INSTALLMENT, AND THE FIRST MONTH’S PROGRAMMING AND FEES IS DUE.

ARE YOU A CURRENT DISH NETWORK CUSTOMER? _____ NO _____ YES

IF YES, WHAT IS YOUR DISH NETWORK ACCOUNT NUMBER? ______

FOR ANY QUESTIONS, PLEASE CALL 859-282-2000 EXTENSION 109.

Thank You! Now you may…

-First, Save this form to your computer. Then fill it out and save it again. Then email that saved and completed form as an attachment to [email protected]

-Print this form and Fax the completed 2-page form to (859) 282-2001 – The Satellite Center

-Mail this form to:

The Satellite Center Inc. 7501 Woodspoint Dr. Florence, KY 41042