Sign Up Form - Acd Net
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1The Durant
Call 866-455-1982 to order DIRECTV service
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MOVE-IN DATE
RESIDENT FIRST NAME
M.I.
LAST NAME
SERVICE ADDRESS #
STREET NAME
UNIT #
-
-
E. MAIL ADDRESS
Social Security # (Required)
-
SUBSCRIBER PHONE #
Credit Card (Must have credit card on file)
expires
CV2 #
1. Select one of three great offers:
24 MONTH OFFER:
Includes up to $29 off for 12 mos. Free receiver lease upgrades and more
12 MONTH OFFER:
Includes a $58.99 one-time bill credit (online rebate)
MONTH TO MONTH OFFER:
ADD $100.00 Standard/Advanced Receiver “NO Agreement Fee”
)
($5.00/mo. will be credited back to customers account until fee is exhausted
No Agreement Fee:
$100
= __________
2. Choose your receiver from below:
$0
=
Requires CHOICE ($58.99 month)
SD Receiver:
$50
=
Requires XTRA Plus DVR ($70.99 month)
SD DVR Receiver:
$50
=
Requires XTRA + HD ($73.99 month)
HD Receiver:
$150
=
Requires XTRA + HD & DVR ($80.99 month)
HD DVR Receiver:
Add Handling Fee:
3.
=
$25
Total Paid $ __________
I wish to have DIRECTV service in my apartment. A single standard receiver is included free for each new subscriber with a
12 or 24 month agreement, and additional receivers may be obtained at additional cost. Activation of the required package
or higher is necessary for a free receiver and installation. Installation will be arranged by S&S Broadband on a first come /
first served basis. NOTE that all receivers are leased. Upon termination call DIRECTV at 800-531-5000 and request a
postage paid receiver recovery kit to return receivers. If you do not return all leased equipment upon termination of service or
do not complete the commitment period you will be responsible for early termination or non return fees (see lease addendum
for details).
Signature
Date
Return this form with payment to:
S&S Broadband Services
12137 Merriman Rd
Livonia, Mi 48150
Or fax form to 734-838-3289
Rev: 8-05-10
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