Dish Network Programming Request Form
                                   For Dallas/Fort worth metroplex residents Only.


   * Please fill the below information. Fields marked with (*) are required.
   * This form is to save each others time in exchanging information.
   * We will call you to confirm and answer any questions you may have before finally confirming the     Order.
  * We offer all the channels thru Dish Network. All the Dish Network specials apply. For details of      current specials and list of American and International channels, please visit www.dishnetwork.com.
  * All Dishnetwork Specials Apply
 *Residential Custom Agreement from Dish Network, Click Here.
 *Current Dish Network Specials, Click Here.
  * Gemini TV is an exclusive channel pointing to a different Satellite. You need a separate new dish.
              Programming for new Dish customers. For all other programming pricing, pl. visit the above Dish links.


* First Name
: 
   Middle Initial
: 
* Last Name
: 
* Address1
: 
   Address2
: 
* City
: 
* State
: 
* ZipCode
: 

Type of Home:
Single Family Home Apartment Condo
(Please Specify if other)
  
Note 1:
*
 Single Family Home: Community regulations must be followed at many places for installing the Dish.
*
 Please make sure that you get the information before the installation. Re-Scheduling the installation or relocating the Dish can be charged.
*
 Apartment/Condo: Permission from the Owners must be taken prior to the Installation. Re-Scheduling the installation or relocating the Dish can be charged.

* Home Phone Number :
   - -
* Mobile/Work Number :
   - -
     * Best number to Contact :
Home Mobile/Work

     * Do you have Dish Network at your home currently?
 
Yes
No  
     * If 'yes' what programming do you have?
American
 International Local  
     * What programming would you like to get?
American
 International Local Gemini TV

How soon do you need the installation?
  
* All the installations are done in the Order they received. Please keep up with us.
How many receivers do you need?
   Number only
If you are living in an Apartment/Condo,
Please mention the direction the balcony
(or any other provision) is facing :
  
 *  Note2: This will help us serve you better and waive any charges for the Installer visit under unsuccessful installation      situations.
*
 Our representative will call you to confirm the Order.
*
 All the orders are subject to a Credit card guarantee.
*
 Your credit card will be charged for the installer visit when the installation not successful due to direction and Authorization disputes.
Surya Communications
Phone: 972-387-8793,
dish@andhravaani.com
Hot Breads is our advertising and services partner.
Any issues relating to the installation are to be addressed to Surya Communications.