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| Please print and complete and fax or
mail it to address below:World Wide Satellite Discount Agreement
I want my equipment/installation discount of $____________! In order to qualify, I must: Sign and complete all elements of this Agreement form. Include valid major credit card on the form with my name and billing address on it. Install my system and activate the required programming for one year (see below). Pay my first programming bill in full (which will be for my first two months).
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 Date
Please check one:
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| In the event that you fail to maintain
qualified programming for 12 consecutive months, you hereby authorize World Wide Satellite
to charge a fee equal to the amount of programming set forth below and
authorize the issuer of the credit card to pay that amount and whatever other discounts
you received. You authorize such charge without World Wide Satellite submitting a signed
receipt and agree that this Agreement is to be accepted as such authorization. You
acknowledge and agree that World Wide Satellite is not extending credit to you and that
the cancellation fee is not interest, a credit service charge or a finance charge. I hereby acknowledge that I have read, understand and agree to be bound by the terms and conditions found on this Agreement.
Customer Minimum Programming Choices  DirecTV -12 consecutive months of Total Choice $29.99/mo.
Dish Network -12 consecutive months of Top 40 $19.99/mo.
S/N:_____________________________________ Card#: ______________________________________ Brand Name: _____________________________ Model #: _____________________________________ S/N:_____________________________________ Card#: ________________________________________ Other_____________________________________________________________ |
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