Required InformationCredit Card ___________________________ Credit Debit

Name on Card _______________________________________

Credit Card # ________________________________________

Exp Date _________________________ 3 Digit Code _______

Social Security # ___________________ DOB ______________

Credit Card–extra equip Mthly Draft Mthly Invoice

Premium Channels HBO-$1499 Choose 1-$1299

Starz-$1299 Choose 2-$2400

Cinemax-$1299 Choose 3-$3400

Showtime-$1299 Choose 4-$4200

Sports Pack-$1299

Add $2 for any package with HBO

Preferred Install Date

1st Choice ______________

2nd Choice ______________

3rd Choice ______________

Wize Guyz115 E Blackstock, Unit DSpartanburg, SC 29301

864-576-7789 or 864-552-1070

800-815-0277

Base Programming $_________DVR Service $_________Whole Home DVR Service $_________HD Programming and/or HD Extra Pack $_________International Programming $_________TV Receiver Lease Fees $_________Premium Packages $_________Protection Plan $_________Estimated Monthly Total before Rebates $_________Discount $_________Monthly Rebates $_________Estimated Monthly Total after Rebates $_________

Things to Remember•Commitment is 24 months•Estimate only – Pricing may vary•Standard Installation Included•If dish is on a pole, additional charges may apply•Fee Based $200 or $300 – upgrades are more•$19.95 S & H Fee or FREE shipping for 3 referrals: Referral Phone # / Relationship

1 ___________________________________

_________________ _________________

2 ___________________________________

_________________ _________________

3 ___________________________________

_________________ _________________

How did You hear of Wize Guyz?Current Customer _________________________

Walk-In Billboard Radio TV _________________________ Flyer - Promo Code ______________________ BP - Promo Code _______________________ SA - Promo Code _______________________

DIRECTV New Customer Qualifying WorksheetDate __________________________

WG Rep __________ Promo Code ____

Phone _________________________

E-mail _________________________

Location _______________________

TV Receivers 1st TV Free 2nd TV $5 3rd TV $10 4th TV $15 5th TV $20 6th TV $25

International International must have base package Basic Choice $12.99 Jade World $39.99 Preferred Choice Free HD w/Autodraft $38.99 $19.99 A la Carte package ______________________________________

Customer _____________________ Ref. Acct# ________________________

Bill to Address __________________________________________________

Install Address ____________________________ City _________________

ST/Zip _________________ Email _________________________________

Phone ______________________ Cell _____________________________

Consent to SwitchPlease cancel for me, my current account: Charter: TV Internet Phone Dish Network AT&T: TV Internet Phone Other ____________

•I agree to allow us to switch my current account to Wize Guyz DIRECTV Yes, switch me•I declare: All contracts have expired I am currently under contract _______________

Name on Existing Account ________________________________________

Address __________________________________________________

_________________________________________________________

Existing: Account # ____________ Phone # _________________________

Transferred by : WG rep _____________________ Date ________________

By signing below, I agree to all terms & conditions on this sheet and declare all information to be true.

Signature ________________________________________________________

800-815-0277

www.wizeguyzonline.com

AMPM

AMPM

AMPM

Programming Std. Fee Upgrade Fee Switch Promotion Free Cinema Kit with HD DVR HD Free

Choice $58.99 $29.99$29 Rebate for 1 yr150 + ChannelsFree Showtime 3 Months

Choice Xtra $63.99 $34.99$29 Rebate for 1 yr210 + ChannelsFree Starz & ShowTime 3 MonthsFree HD with Autodraft

Choice Ultimate $68.99 $39.99$29 Rebate for 1 yr225 + Channels plus Free Starz & Showtime 3 monthsFREE HD with Autodraft

Premier $114.99$61.99 (Mo. 1-3), $85.99 (Mo. 4-12)285 Top ChannelsAll Movie Channels & Sports PackFree HD with Autodraft

Programming Add–Ons: DVR $7 Whole Home DVR $3 HD $10 HD X Pack $4.99 Mas Mexico + 7.99 Mas Americas + 7.99 En Espanol $14.99

Latino Programming Más Mexico – 2 Std Receivers $29.99 $24.99 Optimo Más $44.99 $34.99 Más Ultra – Free HD with Autodraft $59.99 $39.99 Lo Maximo $114.99 $70.99 (Mo. 1-3), $94.99 (Mo. 4-12) Free HD with Autodraft

Equipment

Standard Receiver = $69.00 X # ______ = $ _______

Standard DVR = $99.00 X # ______ = $ _______

HD Receiver = $99.00 X # ______ = $ _______

HD DVR = $199.00 X # ______ = $ _______

Total Equipment Cost = $ _______

•4 standard receivers Free with Choice•1 Free Upgrade to DVR, HD DVR, or HD Receiver with Choice Xtra•1 Additional Free HD Receiver (must have HD DVR and

whole home service)

Upstate SC