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:	AL (Alabama) AK (Alaska) AZ (Arizona) AR (Arkansas) CA (California) CO (Colorado) CT (Connecticut) DE (Delaware) DC (District of Columbia) FL (Florida) GA (Georgia) HI (Hawaii) ID (Idaho) IL (Illinois) IN (Indiana) IA (Iowa) KS (Kansas) KY (Kentucky) LA (Louisiana) ME (Maine) MD (Maryland) MA (Massachusetts) MI (Michigan) MN (Minnesota) MS (Mississippi) MO (Missouri) MT (Montana) NE (Nebraska) NV (Nevada) NH (New Hampshire) NJ (New Jersey) NY (New York) NC (North Carolina) ND (North Dakota) OH (Ohio) OK (Oklahoma) OR (Oregon) PA (Pennsylvania) RI (Rhode Island) SC (South Carolina) SD (South Dakota) TN (Tennessee) TX (Texas) UT (Utah) VT (Vermont) VA (Virginia) WA (Washington) WV (West Virginia) WI (Wisconsin) WY (Wyoming)
* ZIP Code:
* Primary Contact Number:
Secondary Contact Number:

Purchase Information:
* Please choose your Premium Services:
	HD DVR $16.95 per month
	Additional HD DVR $8.95 per month
	Number of additional boxes:
Cinemax HD, Speed HD & Golf Channel HD, HBO HD, Showtime HD, and Starz HD require a subscription to their respective packages.
Would you like to upgrade to one or more Prime Pics Extra packages?
	Cinemax $11.50 per month view listing
	Fan's Choice $5.95 per month view listing
	HBO $14.50 per month view listing
	Showtime/TMC $11.50 per month view listing
	Starz (w/ Encore) $12.95 per month view listing

Additional Information:
To help us better serve our customers, please take a moment to answer the following questions.
To which Shentel cable package do you currently subscribe?	Economy (12 channels) Better Basic (67 channels) Prime Pics (168 channels)
To which other Shentel services do you currently subscribe? 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.

Verification & Signature:
* Please enter the code displayed below in this box:    Listen to the code Try a different code
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