<p> Dish Network Residential Form for The Satellite Center – 859-282-2000 Ext. 109</p><p>Place an “X” to select your monthly programming and equipment: Click on the package to link to more information, or visit dishnetwork.com/packages</p><p>_____ 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</p><p>--PRICES AND CHANNELS IN PACKAGES ARE SUBJECT TO CHANGE WITHOUT NOTICE--</p><p>Do you want HD programming? _____ Yes – Add’l $10 per month. _____ No</p><p>TYPE OF RECEIVER WANTED: ____ VIP211K* $85.00 ($75.00 + $10.00 shipping) -Can only be used on one (1) TV</p><p>____ 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.</p><p>* Standard residential receivers will not work on this system</p><p>NUMBER OF OUTLETS (MAXIMUM OF 2 INDEPENDENT OUTLETS) ______</p><p>Information We Need to Set-Up Your Account:</p><p>NAME ______</p><p>ADDRESS ______</p><p>CITY ______STATE ______ZIP______</p><p>TELEPHONE NUMBER ______CELL NUMBER ______</p><p>SOCIAL SECURITY NUMBER ______(Required to set up account, leave blank to have us call you)</p><p>SALES TAX WILL BE ADDED TO ALL PRICES.</p><p>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.</p><p>AT INSTALLATION, THE INSTALLATION CHARGE, THE RECEIVER INSTALLMENT, AND THE FIRST MONTH’S PROGRAMMING AND FEES IS DUE.</p><p>ARE YOU A CURRENT DISH NETWORK CUSTOMER? _____ NO _____ YES</p><p>IF YES, WHAT IS YOUR DISH NETWORK ACCOUNT NUMBER? ______</p><p>FOR ANY QUESTIONS, PLEASE CALL 859-282-2000 EXTENSION 109.</p><p>Thank You! Now you may…</p><p>-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]</p><p>Or</p><p>-Print this form and Fax the completed 2-page form to (859) 282-2001 – The Satellite Center</p><p>Or</p><p>-Mail this form to: </p><p>The Satellite Center Inc. 7501 Woodspoint Dr. Florence, KY 41042</p><p>2</p>