High-Definition DVR Pre-order Form

Use the form below to add HD DVR service to your existing Shentel Digital Cable service. Once submitted, a Customer Service Representative will contact you to schedule a date and time to install your HD DVR equipment.

You must be a Shentel Digital Cable customer in order to get Shentel HD/DVR service. Please contact customer service at 1.800.SHENTEL to sign up for Digital Cable service.

* = Required Information

Personal Information:
* First Name:
* Last Name:
* Physical Address:
* City:
* State:
* ZIP Code:
* Primary Contact Number:
Secondary Contact Number:

Purchase Information:
* Please choose your Premium Services:
	HD DVR $15.95 per month
	Additional HD DVR $8.95 per month
	Number of additional boxes:
HBO HD, CINEMAX HD and Showtime HD require a subscription to their respective packages.
Would you like to upgrade to one or more Prime Pics Extra packages?
	Cinemax $9.95 per month view listing
	HBO $12.95 per month view listing
	Showtime/TMC $9.95 per month view listing

Additional Information:
To help us better serve our customers, please take a moment to answer the following questions.
What Shentel cable package do you currently subscribe to?
What other services from Shentel do you currently subscribe to? check all that apply	Dial-Up Internet DSL Internet Telephone Security
How did you hear about Shentel Cable's High-Definition DVR?
Newspaper	Radio
Bill insert	Cable TV
Shentel.net	Shenandoah.com
Billboard	Brochure
Shentel Store	Word of mouth/friend
Other: Please explain.

Remarks and special instructions:
If you have any additional comments or questions please include them below.

Signature:
By submitting the information on this form, I am aware that I am signing up for Shentel Cable HD DVR service and I am responsible for all related charges. * I Agree
* = Required field

High-Definition DVR Pre-order Form

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