Residential SMATV (MTS) New Customer Programming Order Form (page 1 of 3) Complete this form on-screen, print for signature then FAX: 800 933 4631 Property Name Please select the programming services you wish to order by checking the appropriate boxes below. Enter the package or service price for each selection using the Residential SMATV Programming Rate Card. Use the per unit price corresponding to your number of Subscriber Units. Each programming service in a DIRECTV® package or bundled service requires a dedicated DIRECTV® Receiver (IRD). In certain areas, service may be unavailable or additional restrictions may apply. SELECT # OF UNITS PRICE TOTAL Adventure Package $.50/unit Business Networks $.50/unit Disney Pack $.75/unit ESPN Suites $3.10/unit Facts & Fantasy $.25/unit Fox Sports Suite $1.35/unit The Fundamentals $1.25/unit Family Favorites $.50/unit Great Entertainment $.50/unit XM Satellite Radio $.17/unit Local Channels $49.99 Per Property HBO The Works (7 channels & HBO Latino) $4.00/unit SHOWTIME, FLIX & Sundance Channel $4.10/unit SHOWTIME UNLIMITED (see Rate Card for details) $5.00/unit Starz Super Pack/Encore $3.75/unit SHOWTIME (5 channels) $3.00/unit MTS Account # Packaged Services Premium Services CINEMAX (3channels) $3.50/unit Starz/Encore + 3 Themes $3.30/unit Starz/Encore + 1 Theme $3.00/unit Starz/Encore (see Rate Card for details) $3.75/unit Encore + 6 Themes (8 channels) $1.95/unit Encore + 3 Themes (5 channels) $1.35/unit Encore + 1 Theme (3 channels) $.95/unit Encore (2 channels: East & West) $.75/unit Sub Total 1 Sub Total 2 Music Extra $.35/unit Revised 1/23/2008
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Residential SMATV (MTS) New CustomerProgramming Order Form (page 1 of 3)
Complete this form on-screen, print for signature then FAX: 800 933 4631
Property Name
Please select the programming services you wish to order by checking the appropriate boxes below. Enter the package orservice price for each selection using the Residential SMATV Programming Rate Card. Use the per unit price correspondingto your number of Subscriber Units. Each programming service in a DIRECTV® package or bundled service requires adedicated DIRECTV® Receiver (IRD). In certain areas, service may be unavailable or additional restrictions may apply.
SELECT # OF UNITS PRICE TOTAL
Adventure Package $.50/unit
Business Networks $.50/unit
Disney Pack $.75/unit
ESPN Suites $3.10/unit
Facts & Fantasy $.25/unit
Fox Sports Suite $1.35/unit
The Fundamentals $1.25/unit
Family Favorites $.50/unit
Great Entertainment $.50/unit
XM Satellite Radio $.17/unit
Local Channels $49.99 Per Property
HBO The Works (7 channels & HBO Latino) $4.00/unit
SHOWTIME, FLIX & Sundance Channel $4.10/unit
SHOWTIME UNLIMITED (see Rate Card for details) $5.00/unit
Starz Super Pack/Encore $3.75/unit
SHOWTIME (5 channels) $3.00/unit
MTS Account #
Packaged Services
Premium Services
CINEMAX (3channels) $3.50/unit
Starz/Encore + 3 Themes $3.30/unit
Starz/Encore + 1 Theme $3.00/unit
Starz/Encore (see Rate Card for details) $3.75/unit
Encore + 6 Themes (8 channels) $1.95/unit
Encore + 3 Themes (5 channels) $1.35/unit
Encore + 1 Theme (3 channels) $.95/unit
Encore (2 channels: East & West) $.75/unit
Sub Total 1
Sub Total 2
Music Extra $.35/unit
Revised 1/23/2008
Residential SMATV (MTS) New CustomerProgramming Order Form (page 2 of 3)
SELECT # OF UNITS PRICE TOTAL
A&E, History Channel & Di scovery Health $.35/unitBBC America & Current TV $.20/unitBlack Entertainment TV & Gameshow Network $.15/unitBravo, Intl Film Channel & Women's Entertainment $.35/unitCSPAN & CSPAN2 $.08/unit
Turner Classic Movies & CNN $.30/unitCollege Sports Television (CSTV) $.15/unit