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Thank you for your interest in business programming for your business establishment. Please complete the form below and one of our Business Customer Service Representatives will contact you shortly.

Company Name		Address
Contact Name		City
Contact Title		State
Telephone		ZIP Code
Fax Telephone		Email Address

Do you own or lease the building?

Own
Lease

Approximate square footage of building.

square feet

Do you currently have cable or satellite service in the building?

Yes
No

If yes, who is the provider?

If yes, what do you pay per month?

$ per month

If yes, are you currently under a contract?

Yes
No

If yes, when does the contract expire?

MM/DD/YY

Healthcare Facilities - How many beds does your facility have?

How many rooms does the premises have?

How many televisions are currently on the premises?

Do you plan to add additional televisions?

Yes
No

How many independent television receivers require separate signals?

Is the building single story or multi story?

Single
Multi

What is the roof type?

Flat
Pitched

What type of business is your establishment?

What channels/programs MUST be available?
(Maximum 5 choices)

Channel Choice

Providing Satellite Sales, and Service throughout the US

Telephone: 800-540-9337 Facsimile: 916-681-6811 Email: davejohnson@wildblue.net

Office Hours: Monday to Saturday: 8:00 am - 5:00 pm, Closed on Sundays
- Pacific Standard Time -

Channel Choice is an authorized retailer of DISH Network L.L.C. DISH, DISH Network and DISH Network logos are trademarks, registered trademarks and/or service marks of DISH Network L.L.C. and/or its affiliate(s). The DISH Network trademarks, registered trademarks and/or service marks are used under license of DISH Network L.L.C. and/or its affiliate(s).

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