Customer Information
Your First name: (must be over the age of 18)	* required
Last name:	* required
Email address:	* required
Phone Number:	* required
Service address:
Residential Services Requested: (check all that apply)
Cable Television Basic ...$15.95 Extended Basic...$46.95 Digital....$58.95	Internet 1 Mbps....$29.95 5 Mbps....$39.95 10 Mbps....$49.95	Phones Phone....$24.95 (If you have Internet with SMU) Phone....$39.95 (No Internet from SMU)
	Bundled Services - Television + Internet (per mo) Extended Basic + 5 Mbps Internet....$79.95 Extended Basic + 10 Mbps Internet ....$89.95 Digital Cable + 5 Mbps Internet....$89.95 Digital Cable + 10 Mbps Internet....$99.95 Bundled Services - Television + Internet + Phone (per mo) Basic Cable + 1 Mbps Internet + Phone....$69.95 Extended Basic + 1 Mbps Internet + Phone....$93.95 Extended Basic + 5 Mbps Internet + Phone....$103.95 Extended Basic + 10 Mbps Internet + Phone....$113.95 Digital Cable + 5 Mbps Internet + Phone....$113.95 Digital Cable + 10 Mbps Internet + Phone....$123.95 Additional Services (per mo) Additional Set-Top_box(es)....$3.95 No. of STB(s) 2 3 4 5   Router(Wireless Internet)....$4.95
Option For Digital Cable Television Subscribers: (Check all that apply)
High-Definition Package....$5.95	Note: HBO-HD available only if you have HBO Premium Channel Package         Cinemax-HD available only if you have Cinemax Premium Channel Package         Showtime-HD available only if you have Showtime Premium Channel Package         Starz!-HD available only if you have Starz! Premium Channel Package
Premium Channel Packages HBO Package Cinemax Package Showtime Package Starz! & Encore Package Adult Package	Premium Channel Pricing  First Package.............$9.95 Second Package.........$8.95 Third Package.............$7.95 Additional Packages....$6.95