First Name   Last Name  
     
         
  Email Address   Zip Code  
     
         
  Daytime Cell Number   Evening Install Phone Number  
     
         
  Where will the system be installed?
  
     
  Do you have a credit card?      Yes         No
  
     
  Are you a current customer?    Yes        No
  

*Services and equipment must be ordered, installed and activated between and including February 1, 2010 and May 31, 2010. Only 1 participant per household. This offer may not be combined with any other offer. This offer is limited to: (A) new, first-time residential DISH subscribers; and (B) former DISH subscribers who (1) previously maintained an active DISH account in good standing for at least 6 consecutive months; (2) voluntarily disconnected all prior DISH accounts; (3) paid all balances owing under their prior DISH account(s) in full; and (4) have not received any DISH service during the 3-month period prior to activation under this promotion (“Former DISH Subscribers”). No new, first-time residential DISH subscriber or Former DISH Subscriber shall be eligible for this promotion unless such subscriber: (a) resides in the continental United States, Hawaii or certain areas in Alaska; (b) provides DISH with a social security number and a valid major credit card or debit/check card number, each issued to the customer who signs this Agreement; and (c) receives credit approval. If you reside in Alaska, you represent that you have confirmed that your residence is eligible for this promotion. DISH will determine eligibility and may deny eligibility for any reason. Required Minimum Programming Packages: You must subscribe at all times to one of the “Required Minimum Programming Packages” listed in the table below or a higher programming package. You represent that you have been informed whether you are eligible to receive local network channels by satellite. Limit 6 tuners per account. Lease upgrade fee will apply for select receivers based on model. All prices, packages and programming subject to change without notice. Local and state sales taxes may apply. Where applicable, equipment rental fees and programming are taxed separately. All DISH Network programming, and any other services that are provided, are subject to the terms and conditions of the promotional agreement and Residential Customer Agreement, available at www.dishnetwork.com or upon request. All service marks and trademarks belong to their respective owners.
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