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CONTACT / INSTALLATION ADDRESS

Contact / Installation Address

First Name: *	Last Name: *
Daytime Phone: *	Evening Phone:
Installation Address: *	Apt/Suite #:
City: *	State: *
Zip: *	Email: *
Do You Own The Residence? If you do not own the residence you will need permission for Dish Network to install a satellite dish on the premises.	Yes No
Is your current residence single-family or multi-unit?	Single-family Multi-unit
Select your top 3 preferred installation times. To select more than one, hold down the control key while making your selection.
Other installation instructions
*Required Field

DISH PACKAGE SUMMARY

$0.00

TV Installation

FREE

HD Programming

$0.00

Lease Fee

$0.00

DVR Receiver

FREE

DVR Service

$6.00

Movie Packages

$0.00

Movie Pkg. Discount

$0.00

12 Month Discount

$0.00

Before Discount:

$0.00

After Discount:

$0.00

DISH Network

DISH Network, the fastest growing low-cost satellite TV provider offers the choicest variety of entertainment to over 14 million people across the US. DISH Network packages include movies, sports, news, and more to satisfy the entire family.

DIRECTV

A pioneer in satellite TV industry, DIRECTV offers the best TV entertainment to over 18 million people in America. You get anything from movies and sports to news and information to keep the whole family happy with DIRECTV programming packages.

FiOS TV

FiOS TV is one of the leading names in TV entertainment. It used fiber optics technology to bring superior quality picture and sound to the customers. The FiOS TV is at present available in select parts of America.

CHOOSE OPTIONS

Programming Package:	* with agreement Local Channels (where available)
How Many TVs Do You Have?	Free Standard Professional Installation ( Up to Six Rooms ) *
HD Programming: What is HD Programming?	How many of your TVs are High Definition (HD)? If you have more than 2 HDTV's Please call for pricing.

DVR Service: What is DVR Service?	DVR Service - $6.00//Month - (Fee applies with Agreement)
Premium Programming: Order More Packages and Save: 2 Movie Packages - $22/mo 3 Movie Packages - $31/mo 4 Movie Packages - $40/mo	HBO^® Package - Includes 8 Channels Starz Package - Includes 5 Channels SHOWTIME^® Package - Includes 8 Channels Cinemax^� Package - Includes 5 Channels
Promotional Offers:	HD Free For Life* Free HD-DVR Receiver upgrade* - Requires HD Service Pick Your Premium (HBO, Cinemax or Starz) Offer for 3 Months* DISH Platinum Free for 3 Months* Protection Plan Free for 6 Months BLOCKBUSTER� Movie Pass� included when you sign up for DISH Network (Up to 12 months with qualifying packages.Offer based on the discounted $5 price for the Blockbuster Movie Pass. One disc at time, $10/mo value)

Order DISH Network Satellite TV :

Do You Own The Residence?

DISH PACKAGE SUMMARY

DISH Network

DIRECTV

FiOS TV