DirecTV Order Form

DirecTV Order Form

You can reach us at 1-800-272-4309 with any questions
Customer Name*

First NameLast Name
Email Address *
example@example.com
Best Contact #*
Please enter a valid phone number.Format: (000) 000-0000.
Secondary Contact #
Please enter a valid phone number.Format: (000) 000-0000.
Service Address*

Street Address

Street Address Line 2

CityState

Zip Code
Important: Which provider are you with now & what SERVICES do you currently have?*
Provider name / Satellite / Cable / Internet
Did you just move into the home & are you looking for brand new service?*
Yes or No
DirecTV Packages Available: (Choose one)*

Entertainment package = 160+ Channels - $74.99 per monthChoice package = 185+ Channels includes Sports pack & (LMN) Lifetime Movie Network - $79.99 per monthUltimate package = 250+ Channels - $99.99 per month (Everything included)Premier package = 330+ Channels - $149.99 per month (Everything included)
HBO, Cinemax, Showtime, Starz & EPIX channels are FREE for 3 months. After 3 months, you will be billed $53.99 a month. Would you like me to add these Premium channels to your package FREE of charge for 3 months? You would just need to cancel the subscription before the promotional period ends by calling DirecTV @ 800-531-5000 so you will not be billed.*

Yes. I want the Premium Channels FREE for 3 months.NO, I do not want the Premium channels FREE for 3 months.
How many Boxes? You get the 1st HD DVR box FREE. (Each additional HD DVR Box is $7.00 per box, per month)*

0123456
Do you want to add 10GB Internet from Hughes for $59.99 a month + $14.99 a month to lease the equipment? (Customer is charged today)*

Yes, I want High Speed Internet with Hughes.No, I do NOT want Hughes Internet service.
Would you like to add Home phone service with Hughes for an additional $24.95 per month? (Customer is charged today)*

Yes, I want like to add Home phone service with Hughes for an additional $24.95 per monthNo, I do NOT want Hughes Home phone service
Select the best time for an agent to call you back with a free quote?*
Is there a specific time you would prefer us to call?
Should be Empty: