| Movie Multiplex: (must have Basic Digital CATV to purchase any movie multiplex channels) |
| Pick 1 |
$13.00 |
___Starz/Encore (11) |
$13.00 |
___Cinemax (4) |
| |
$15.00 |
___HBO(6) |
$15.00 |
___Showtime (10) |
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| Pick 2: |
$27.00 |
___Starz/Encore |
___Cinemax |
___HBO |
___Showtime |
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| Pick 3: |
$40.00 |
___Starz/Encore |
___Cinemax |
___HBO |
___Showtime |
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| ___ Total Digital: $99.95 (143 Channels, including all four Movie Multiplex) |
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| Block Pay-Per-View: |
Yes______ No_____ (if not blocked I agree to pay all pay-per-view fees on my service) |
| Pay-Per_View Credit Line: |
_____$25.00 _____$50.00 _____$100.00 |
|
| Digital Receivers: First Receiver and REmote Included with Basic Service* |
| Additional Digital Receiver: |
_____Purchase Price $299.95 + tax |
| Remote Control: |
_____Purchase Price $25.00 + tax |
| *Digital REceiver/Remote: |
_____Lease Price $7.00 (per month) |
| * Subscriber is responsible for replacement cost of equipment if damage not covered by warranty |
| _____Membership |
$20.00 |
| _____Installation |
$20.00 |
| _____Move Service |
$10.00 |
| _____Reconnect Fee |
$20.00 |
| _____Seasonal Reconnect |
$20.00 |
|
(Office Use Only) |
Motorola Equipment |
| SN__________________ |
UA__________________ |
| SN__________________ |
UA__________________ |
| SN__________________ |
UA__________________ |
|
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Is there a phone jack near the TV? _____ Yes _____No |
Fees payable with application: $20.00 installation plus one month's services |
Make check payable to: Panora Telco, PO Box 189, Panora, IA 50216 |
| Installation fees covers bringing signal into your property. * If additional work is required this would be billed at $45.00 per hour plus materials. All monthly fees are plus tax: |
| Comments:________________________________________________________________________________________________ |
| _________________________________________________________________________________________________________ |
