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SUBSCRIBER ADDRESS
* Last Name:
* First Name:
* Address:

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* Phone Number w/area code:	- -	(Night)
* Email:

BILLING AND CREDIT CARD INFORMATION Enter your credit card information as it appears on your billing statement
Same address as above
* Last Name:
* First Name:
* Address:

* City:

* State:

* Zipcode:

* Phone Number w/area code:	- -	(Day)
* Phone Number w/area code:	- -	(Night)
* Email:

* Credit Card Type:
* Credit Card Number:	- - -
* 3 Digit CSV Code:
(This is the 3 digit code found in the signature panel on the back of your credit card)
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Upgrades: Please choose your upgrade selection:
Dish DVR
	Yes, please upgrade my primary receiver to a Dish DVR.
	No, not interested at this time. I understand that if I choose to add a Dish DVR or an additional receiver after my installation date, there will be additional charges.

Please Read:

Basic installation of up to 4 tuners is FREE with Digital Home Advantage, there is no equipment to buy. Any and all programming credits are fulfilled directly by Dish Network. Intertech is not responsible for any and all programming credits. Satellite TV installation outside of Western New York and Northwestern Pennsylvania is completed by professional Dish Network installers. Satellite TV installation in Western New York is completed by professional Intertech Digital Entertainment installers.
Please read our Terms & Conditions before submitting your order.

Total amount charged to credit card:
Upon confirmation of your order, you will be ready to schedule your installation. You will be contacted by Dish Network if you are outside the Western New York area. Western New York residents will be contacted directly by Intertech Digital Entertainment to schedule installation.


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