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Wireless Areas
Access Numbers
Name:
Email Address:
Street Address:
City:
State:
Zip Code:
Phone #:
(If Preferred)
Which Services Are you Interested in?
Wireless Internet
(As Low As $19.95/month)
Dial-Up Internet
(As Low As $7.95/month)
Accelerated Dial-Up Internet
(As Low As $14.90/month)
Dish Network Television
VOIP Telephone
Would you be interested in receiving a discount for making automatic payments?
Yes
($5/month Discount)
No
What length of contract would you be interested in signing up for?
3 Year
($149 Setup Fee with $5/month discount)
1 Year
($149 Setup Fee)
No Contract
($199 Setup Fee)
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