BirdsEyeTv

Low Cost & Budget Entertainment

Affordable Tv Services
Customer Application Form

No Credit Check!
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
One Device is included with your BirdsEyeTv service,,The box / Receiver is $165.99 . Service to one box is $30 , service to each additional box is $5 per box on monthly bill
Number of boxes? Additional boxes are 95.99 ea.*

1 Box2 Box3 Box4 Box
Desired Installation date?*

MonthDayYear
Date
What’s Your Time Availability *

:HourAM/PM Option
Until
until :HourAM/PM Option
Adult content*

YesNo
BirdsEyeTv Requires High-Speed internet. Recommeded minimum 50 mbps per stream for optimal Viewing.*

I already Have High speed InternetI Also need High speed Internet
Who referred you?
For BirdsEyeTv with one box , $165.99 needs to be paid, then service will be $30 per month, are you able to pay the $165.99 Today?*
Will you be paying With Credit/,Debit card or PayPal Please state which one.*
No Gift cards will be accepted!
Are you ok with all of the Requirements? If not please explain?
Any questions.....Feel free to call me @

423-633-2474
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My Products
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Digital Box Device$165.99

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Low Cost & Budget Entertainment