Please fill out the form below:
Name:
Address:
City:
Phone number:
Email:
Interested In:
Dish Network
Direct TV
Location Type:
Home
Apartment
Have you had Dish or Direct TV before?
No
Yes
If so, how long ago?:
How many TVs do you own?:
Do you want HD?:
No
Yes
Maybe
Do you want a DVR?:
No
Yes
Maybe
Do you have a major credit card or visa debit card?:
No
Yes
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