Residential SMATV (MTS) New Customer Programming Order Form (page 1 of 3) Complete this form on-screen, print for signature then FAX: 800 933 4631 Property Name MTS Account # Please select the programming services you wish to order by checking the appropriate boxes below. Enter the package or service price for each selection using the Residential SMATV Programming Rate Card. Use the per unit price corresponding to your number of Subscriber Units. Each programming service in a DIRECTV® package or bundled service requires a dedicated DIRECTV® Receiver (IRD). In certain areas, service may be unavailable or additional restrictions may apply. Packaged Services SELECT # OF UNITS PRICE TOTAL Adventure Package $.50/unit Business Networks $.50/unit Disney Pack $.75/unit ESPN Suites $3.10/unit Facts & Fantasy $.25/unit Fox Sports Suite $1.35/unit The Fundamentals $1.25/unit Family Favorites $.50/unit Great Entertainment $.50/unit Music Extra $.35/unit XM Satellite Radio $.17/unit Local Channels $49.99 Per Property Sub Total 1 Premium Services HBO The Works (7 channels & HBO Latino) $4.00/unit SHOWTIME UNLIMITED (see Rate Card for details) $5.00/unit SHOWTIME, FLIX & Sundance Channel $4.10/unit SHOWTIME (5 channels) $3.00/unit Starz Super Pack/Encore $3.75/unit CINEMAX (3channels) $3.50/unit Starz/Encore + 3 Themes $3.30/unit Starz/Encore + 1 Theme $3.00/unit Starz/Encore (see Rate Card for details) $3.75/unit Encore + 6 Themes (8 channels) $1.95/unit Encore + 3 Themes (5 channels) $1.35/unit Encore + 1 Theme (3 channels) $.95/unit Encore (2 channels: East & West) $.75/unit Sub Total 2 Revised 1/23/2008 Residential SMATV (MTS) New Customer Programming Order Form (page 2 of 3) A La Carte and Bundled Services SELECT # OF UNITS PRICE TOTAL A&E, History Channel & Di scovery Health $.35/unit BBC America & Current TV $.20/unit Black Entertainment TV & Gameshow Network $.15/unit Bravo, Intl Film Channel & Women's Entertainment $.35/unit CSPAN & CSPAN2 $.08/unit Turner Classic Movies & CNN $.30/unit College Sports Television (CSTV) $.15/unit Disney Channel (East & West) $.75/unit ESPN $3.85/unit ESPN & ESPN2 $3.65/unit ESPN, ESPN2 & ESPNEWS $3.25/unit Fox Movie Channel $1.00/unit Fox Reality $.15/unit Fox Soccer Channel $.20/unit FUEL TV $.20/unit FX $.30/unit Galavision and Univision $.15/unit The Golf Channel $.25/unit Home & Garden, Food Network & Travel Channel $.15/unit NBA TV $.35/unit NFL Network $.30/unit Noggin, PBS Kids, Nicktoons $.30/unit Speed Channel $.25/unit Sundance Channel $.35/unit Superstation WGN $.14/unit TVLand, Hallmark Channel, Lifetime Movie Network $.25/unit International Programming Sub Total 3 AASTHA $.50/unit BanglaDirect $.50/unit HindiDirect $.50/unit JADEWORLD (Jade-E&W, TVBS, Chinese Movie Channel & CCTV-4) $200 (1-999 units) JADEWORLD (Jade-E&W, TVBS, Chinese Movie Channel & CCTV-4) $400 (1000+units) Lo Ecsencial En Espanol: 27 Spanish Language Channels $2.85/unit MandarinDirect $.50/unit SKY TG24 $.50/unit TamilDirect $.50/unit TeluguDirect $.50/unit TFCDirect $.50/unit VietnameseDirect $.50/unit Sub Total 4 Revised 1/23/2008 Residential SMATV (MTS) New Customer Programming Order Form (Page 3 of 3) Regional Sports Networks SELECT # OF UNITS PRICE TOTAL FSN (Fox Sports Net) $.99/unit YES Network In Market NY, NY DMA $1.75/unit YES Network Out of Market for NY & CT $1.50/unit YES Network Out of Market Portions of NJ & PA (zip code Confirmation) $1.50/unit RSN (In-Market Regional Sports $.99/unit Complimentary/Public Interest Free Add-on with purchase of any DIRECTV In-Room Programming Sat 119 *BYUTV 437 *CCTV 455 *DAYSTAR 369 *EWTN 422 *HITN 438 NASATV 376 Sub Total 1 RFDTV 379 Sub Total 2 Sat 101 Sub Total 3 *CSPAN 350 LINKTV 375 Sub Total 4 PBS YOU 377 Applicable Taxes TBN 372 WORD Network 373 TOTAL *Must have DIRECTV Multi-Satellite system to receive these channels. Pricing does not include taxes. Procurement of equipment is customer's responsibility. Include applicable sales tax with total payment. Payment Options Electronic Funds Transfer Recurring Credit Card American Express Credit Card #: Discover Card Exp. Date: MasterCard Optima VISA Name as it appears on credit card Routing Number Account Number Signature of Cardholder Revised 1/23/2008.