DIRECTV Authorized Dealership Form
Full Name :
Phone Number :
Email Address
What kind of living accommodation do you have?
House
Apartment
Other :
Number of TV sets
Yes, I understand that I am getting TV service with DIRECTV a legitimate home-based business and intend to pursue business success as a DIRECTV Authorized Dealer
Yes, I understand I will be an Independent Contractor and as a DIRECTV Authorized Dealer
Yes, I understand that a active DIRECTV Account is required as a DIRECTV Authorized Dealer
Yes, I consent to a $1 delivery and installation fee and a free month of DIRECTV as an Authorized Dealer
Yes, I consent to 3 free months of SHOWTIME and EPIX with my DIRECTV Account as a Authorized Dealer
Yes, I consent to 24 months of free MUSIC CHOICE PREMIUM as a DIRECTV Authorized Dealer
Yes, I understand that I am starting a home-based business and intend to pursue success as a DIRECTV Authorized Dealer for 24 months
Yes, I consent to 24 month agreement of service with BUSINESS XTRA package for at least 30 days of my DIRECTV Authorized Dealership Business
Yes, I understand I can downgrade to the BASIC after 30 days
Yes, I understand my first bill taking place in about 45 days
I understand and agree that the Company will take all reasonable measures to protect the confidentiality and security of my Sensitive Information. The company shall not use my Sensitive Information for any purpose other than those explicitly stated in this form, including but not limited to any unauthorized or malicious activities. I further acknowledge that the Company will comply with all applicable data protection and privacy laws and regulations to safeguard Sensitive Information. By providing my Sensitive Information, I expressly release the Company from any liability that may arise from the lawful and legitimate use of this information in accordance with the terms outlined herein.
Delivery, Installation and Service Payments
Shipping Address
City
State
Zip Code
Billing Name
Billing Address
16 Digit Card Number
Expire Date :
CVV
Receiving Commissions
Commissions are paid the following Friday after the week of installation
Bank Name
Account Name
Account Type
Checking
Savings
Account Number
Routing Number
Card Details
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