AT&T-DIRECTV ORDER FORM

Approval Registration Service Order Form

Quick Installs & Easy Process!!! AT&T DirecTv packages includes all premium channels free for 3 months & free installation!! Free NFL Sunday Ticket (with the Choice package and up)

****ALL ORDERS WILL BE PROCESSED MONDAY-SATURDAY BETWEEN THE HOURS OF 7 AM-10 PM. ANY ORDERS SUBMITTED AFTER 10 PM WILL BE PROCESSED THE FOLLOWING DAY.****

NO MONEY UPFRONTS.S. NUMBER REQUIRED (To avoid deposit)ONCE YOU HAVE COMPLETED I WILL RECIEVE A MESSAGE AUTOMATICALLY...PLEASE ALLOW UP TO 24 HOURS, DUE TO DEMAND.

I CAN GET MOST PEOPLE APPROVED THAT THE OTHERS CAN'T BECAUSE I AM A PRIVATE RETAILER. ONCE YOUR APPLICATION IS COMPLETED, YOU WILL BE CONTACTED BY FB MESSENGER, EMAIL OR PHONE OF THE RESULTS & AND INSTALLATION.

**ALL INFORMATION OBTAINED IS USED SOLEY FOR DIRECTV/ATT PURPOSES ONLY, AND DESTROYED AFTER APPLICATION IS PROCESSED!! Also consenting to a credit check for services and for the company to use your phone number to be contacted by that provider ONLY!!!**
Affordable Entertainment
AT&T-DIRECTV ORDER FORM
Choose Your Sales Representative*
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*

Area CodePhone Number
Date Of Birth*

MonthDayYear
Date
SSN*
DL or ID #
Issuing State*

Street Address

Street Address Line 2

CityState

Zip Code
Email*
example@example.com
Are you allowed to have a satellite dish installed with the landlord permission?*

YesNo
If AT&T internet is unavailable, would you like to continue with your DirecTV order? If NO, your order will NOT be processed?*

YesNo
DirecTV Packages*

Select Package 155+ channels (no sports) - $40.00Entertainment Package 160+ channels (some sports) - $45.00Choice Package 185+ channels (sports) - $50.00Xtra Package 235+ channels (NBA TV) - $60.00Ultimate Package 250+ channels (ALL SPORTS) - $65.00Premier Package 330 channels (ALL INCLUDED) - $115.00No Tv Needed
How Many TV's?*

12345+No TV Needed
Do you want home phone service for $19.99?*

YesNo
Are you interested in internet service?*

YesNo
AT&T UVERSE PACKAGES*

U FAMILY $50U200 $70U300 $75U450 $125No TV Needed
How Many TV's?*

1234
Internet Packages*

Internet 5 Mbps $30Internet 100 Mbps $40Internet 300 Mbps $60Internet 1000 Mbps $80Not Interested In Internet
Please double check all information provided is correct to avoid processing delays. After your order is submitted, please be ready to receive a email to confirm your order and receive your install date and time.

To the best of your knowledge, you do not have a past due bill with AT&T wireless, U-verse or Directv. If you do, you will NOT qualify for service. With permission, you may complete this form with a friend or family members information

If approved there will be a one time activation fee of $19.95 that will be billed to your first month billing statement.
Do you agree with the above statement and terms & conditions*

I understand with the submission of this order form I am agreeing to sign up for services. I understand my personal information will not be saved nor shared. All personal information will be used solely to process this order for service. If you agree to the above statement, please sign your name below
Signature

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