BULK ACTIVATION & CHANGE REQUEST FORM
BULK ACTIVATION & CHANGE REQUEST FORM Reset Form To request activation of a Bulk Subscriber Account: (i) Retailer must fully and correctly complete (with all applicable signatures) this Bulk Activation Form (the “Activation Form”) and (ii) send it to DISH via email to DISH at [email protected] or fax it to DISH at (303)723-3518 at least two (2) full business days prior to the Requested Activation Date specified below. Service is provided subject to the terms and conditions of the Commercial Customer Agreement (the “Commercial Customer Agreement”), which is available on DISH's website at www.dish.com/commercial. Programming prices/rates and packages are subject to change without notice at any time and from time to time in the sole and absolute discretion of DISH for any reason or no reason. All Bulk Programming rates are based on programming being provided to 100% of the total Drops/Units at the Bulk Property, with a minimum prerequisite of ten (10) Drops/Units per Bulk Property. PLEASE TYPE THE INFORMATION IN THE FORM BELOW, SIGN, AND EMAIL TO [email protected] OR FAX TO (303) 723-3518. Request Type Requested Pre-Activation Date Property Type (Pre-activation may not exceed 30 days) System Type Total Drops/Units Requested Full Activation Date Must be 100% Drops/Units Minimum 10 Rooms/Units Retailer Information: Customer/Property Information: Property Name Retailer No. Distributer Retailer Name (if Applicable) Physical Address Company Name City State Phone Zip Code Fax Mailing Address City Contact Name State Phone Email Zip Code Fax Email Promotions Property Account Number HBO or HBO & Cinemax Commitment Offer Plan: To be considered for participation in the HBO or HBO & Cinemax Commitment Offer Plan the Property MUST: (i) be a Qualifying Bulk Subscriber with a minimum of ten (10) total Drops/Units. (ii) subscribe to Bulk Programming services totaling a minimum of Four and 55/100 ($4.55) per Unit per month (exclusive of any applicable taxes or fees) and (iii) enter into a three (3) year agreement. Participation is subject to DISH's approval which may be withheld by DISH in its sole and absolute discretion for any reason or no reason. Rates set forth in the Promotional Offer are subject to Chargeback pursuant to the terms and conditions set forth in the Business Rules. Hierarchy Account Number Property Billing Information: Business Name NEW AMENITY INCENTIVE 60: To be considered for participation in the Amenity Incentive 60 Promotional Program, the Bulk Property MUST: (i) be a Qualifying Bulk Subscriber with a minimum of fifty (50) total Drops/Units, (ii) subscribe to Bulk Programming services totaling a minimum of Nine and 50/100 Dollars ($9.50) per Unit per month (exclusive of any applicable taxes or fees) and (iii) enter into a five (5) year agreement. Only new or reconditioned smartbox, ViP 211(k)(z), or ViP 222(k) receivers are eligible for this Promotional Program and participation is subject to DISH's approval which may be withheld by DISH in its sole and absolute discretion for any reason or no reason. Incentives are subject to Chargeback pursuant to the terms and conditions set forth in the Business Rules. Attention Mailing Address City State Phone Zip Code EXISTING AMENITY INCENTIVE 60: To be considered for participation in the existing Amenity Incentive 60 Promotional Program, the Bulk Property MUST: (i) Not be under a current bulk promotional commitment (ii)upgrade existing equipment to smartbox (iii) be a Qualifying Bulk Subscriber with a minimum of fifty (50) total Drops/Units, (iv) subscribe to Bulk Programming services totaling a minimum of Nine and 50/100 Dollars ($9.50) per Unit per month (exclusive of any applicable taxes or fees) and (v) enter into a new five (5) year agreement. Only new or reconditioned smartbox are eligible for this Promotional Program and participation is subject to DISH's approval which may be withheld by DISH in its sole and absolute discretion for any reason or no reason. Incentives are subject to Chargeback pursuant to the terms and conditions set forth in the Business Rules. Fax Contact Name AT120 Commitment Offer Plan: To be considered for participation in the AT120 Commitment TOTAL PRICE PER DROP Offer Plan the Bulk Property MUST: (i) be a Qualifying Bulk Subscriber with a minimum of ten (10) total Drops/Units, (ii) enter into a three (3) year agreement. Participation is subject to DISH's approval which may be withheld by DISH in its sole and absolute discretion for any reason or no reason. Rates set forth in the Promotional Offer are subject to early termination fee One and 00/100 ($1.00) per Drop/Unit per month for the number of whole months remaining on the Term Commitment, up to and not in excess of Two Thousand Five Hundred and 00/100 Dollars ($2,500.00), pursuant to the terms and conditions set forth in the Business Rules. Property Representative Signature Comments Property Representative Title (i.e. Owner, Manager, etc.) BY SIGNING IN THE APPROPRIATE SPACE DESIGNATED ON THIS ACTIVATION FORM AND SUBMITTING THIS FORM TO DISH, THE BULK PROPERTY AND THE RETAILER: (I) ACKNOWLEDGE AND AGREE TO BE BOUND BY ALL OF THE TERMS AND CONDITIONS OF THIS ACTIVATION FORM, THE COMMERCIAL CUSTOMER AGREEMENT, AND THE BUSINESS RULES WHICH ARE INCORPORATED HEREIN BY REFERENCE AND (II) DECLARE UNDER PENALTY OF PURJURY THAT THE INFORMATION CONTAINED IN THIS ACTIVATION FORM, INCLUDING WITHOUT LIMITATION THE REPORTED TOTAL NUMBER OF DROPS/UNITS, IS TRUE AND CORRECT AND IN COMPLIANCE WITH THE TERMS AND CONDITIONS OF THE COMMERCIAL CUSTOMER SERVICE AGREEMENT AND THE BUSINESS RULES. Total Drops/ Units is defined in the Business Rules. Notwithstanding the foregoing, DISH reserves the right to determine from time to time, in its Sole Discretion, whether total Drops/Units with respect to each such location should more appropriately be determined in a different manner. 6/16/2015 *“DISH Network” and “DISH” are trademarks of DISH Network L.L.C. For purposes of this Activation Form, “DISH Network”, and “DISH” shall mean DISH Network L.L.C. Initial: Operator_____ Additional Bulk Services Add Electronic Programming Guide (EPG) Data Access Service [FTG Headend Locations Only] DISH reserves the right to audit per the applicable agreement(s). HD over Coax (Please type in approved equipment manufacturer) DISH reserves the right to audit per the applicable agreement(s). Manufacturer: Remove Price Per Drop Add Remove $0.25 Add Remove $0.00 Essentials America's Top 120 America's Top 120 (FTG properties only, requires 3 year subscription, see page 1 for terms) Add Add Add Remove Remove Remove Price Per Drop $1.90 $13.65 $6.00 Hospitality Plus (FTG properties only, must subscribe to Essentials or above) Add Remove $0.50 America's Top 200 Add Remove $21.00 America's Top 250 Add Remove $30.50 Add HD (requires minimum subscription of America's Top 120) Add Remove $1.00 Premier (Hospitality Only) *Cannot be used for L-Band Installations Add Remove $3.40 Prime (MDU Only) *G4 or greater smartcard required Add Remove $3.40 DishLATINO Clasico Add Remove $3.75 University Pack (Available to Universities and Student Housing Properties only) Add Remove Core Bulk Programming Packages (please check services ordered) Add Add-On Packages (requires subscription to one core package) Remove $3.05 Price Per Drop Add Remove Dish Movie Pack Add Remove $5.15 Variety Add Remove $0.63 Classic & Country Add Remove $0.58 Education & Arts Add Remove $0.57 Beyond Entertainment Add Remove $0.34 History & More Add Remove $0.69 News & Lifestyle Add Remove $0.39 The Edge Add Remove $0.88 The Escape Add Remove $0.78 Golf Add Remove $0.22 Comedy & Music Add Remove $0.71 Action Pack Add Remove $0.86 Discovery Pack Add Remove $0.11 BET Add Remove $0.16 CNBC Add Remove $0.18 Expanded HD Package Add Remove $0.40 Sirius Music Add Remove $0.18 Pequeño Latino Add Remove $0.17 CNN en Español Add Remove $0.32 Local Networks In-Market Add Remove Over 60 channels of 100% commercial-free music Sports Packages (requires subscription to one core package) $0.50 Price Per Drop Add Remove ESPN A La Carte Add Remove $6.52 ESPN Pak 3 (All channels in the package must be displayed) Add Remove $5.94 ESPN Pak 4 (All channels in the package must be displayed) Add Remove $5.47 ESPN Pak 5 (All channels in the package must be displayed) Add Remove $5.38 ESPN Ultimate (Five (5) of the seven (7) channels in the package must be displayed) Add Remove $6.38 Puerto Rico / Virgin Islands ESPN Package (All channels in the package must be displayed) Add Remove $5.38 ESPN Deportes - Requires Subscription to ESPN pack 4 or 5 (Hotels/Motels Only) (All channels in the package must be displayed) Add Remove $0.00 Multi-Sport Package (available only with America's Top 200 or 250) Add Remove $5.65 Regional Sports a la carte (Hotels/Motels only) Quantity Add Remove $1.05/ea Regional Sports a la carte (all other bulk properties) Quantity Add Remove $1.30/ea Big Ten Network Add Remove $2.24 PAC 12 CBS Sports Network Add Remove $1.99 Add Remove $0.15 Sports Time Ohio Add Remove $2.00 Please Specify SEC Network (Requires AT120) Add Remove $2.00 Longhorn Network (Requires AT 120) Add Remove $0.50 MLB Network Add Remove $0.30 NFL Network Add Remove $0.33 The Tennis Channel Add Remove Premium Packages Add $0.25 Remove Price Per Drop EPIX (FTG properties only, must subscribe to Essentials or above) Add Remove $1.00 HBO Add Remove $4.40 HBO Promotional Rate (New HBO Subscription for Hotel/Motel, Expires 1/15/2016) Add Remove $4.05 HBO Free-to-Guest and Dorms, commitment offer I accept terms and conditions. HBO commitment offer requires a three (3) year subscription. By selecting the promotion on the first page, and submitting to DISH you agree to subscribe to HBO for a period of no less than three (3) years commencing on the date identified on the first page. This contract will be binding and may be renewed automatically for additional one (1) year terms unless you contact DISH customer service to cancel the services. Add Remove $2.75 HBO & Cinemax Add Remove $7.40 HBO & Cinemax Free-to-Guest and Dorms, commitment offer I accept terms and conditions. HBO & Cinemax requires a three (3) year subscription. By selecting the promotion on the first page, and submitting to DISH you agree to subscribe to HBO for a period of no less than three (3) years commencing on the date identified on the first page. This contract will be binding and may be renewed automatically for additional one (1) year term unless you contact DISH customer service to cancel the services. Add Remove $2.75 Showtime Add Remove $3.95 Showtime Promotional Rate (New Showtime Subscription for Hotel/Motel, Expires 1/15/2016) Add Remove $3.05 Starz! Add Remove $3.30 HBO, Cinemax, Showtime, and Starz! Add Remove $14.65 Encore (East/West) Add Remove $0.66 Encore + 1 Add Remove $0.87 Encore + 2 Add Remove $1.08 Encore + 3 Add Remove $1.29 Encore + 4 Add Remove $1.50 Encore + 5 Add Remove $1.71 Encore + 6 (Action, Black, Classic, Family, Suspense, Westerns) Add Remove International Packages Add Remove $1.92 Price Per Drop Arabic - Arabic Enhanced Pack Add Remove $0.60 Brazilian - TV Globo Add Remove $0.85 Brazilian - Brasil Mais Add Remove $1.60 Cantonese: Jadeworld Add Remove Chinese - Chinese Elite Pack Add Remove Chinese - Great Wall TV Package Add Remove $0.35 $1.10 $2.10 French - TV5Monde Add Remove $1.35 French - French Bouquet Add Remove $1.35 German - Mega Add Remove $1.85 Greek - Greek Elite Pack Add Remove $0.50 Hindi - Hindi Mega Pack Add Remove $1.10 Israeli - The Israeli Network Add Remove $0.60 Itailian - RAITALIA Add Remove $0.60 Japanese - TV Japan Add Remove $1.10 Polish - Super Pack Add Remove $0.50 Portuguese - Luso Pack Add Remove Russian - Russian Mega Pack Add Remove $1.10 $1.10 Taiwanese - Taiwanese Elite Pack Add Remove Tamil - Sun TV Add Remove $0.85 $1.10 All rates are based on a per room/unit basis, per month and applied to the total number of units. In order to subscribe to the ESPN Package, all programming in that package must be delivered in each room All channels may not be available if you live in the following areas: Alaska, Puerto Rico, U.S. Virgin Islands, or Hawaii. Please visit our website at www.dish.com/commercial for further details 6/16/2015 *“DISH Network” and “DISH” are trademarks of DISH Network L.L.C. For purposes of this Activation Form, “DISH Network”, and “DISH” shall mean DISH Network L.L.C. Initial: Operator_____ EQUIPMENT INSTRUCTIONS Add All Remove All Clear All Please complete this page if you are activating a new bulk account or adding or removing receivers to an existing bulk account. For SMATV (head end) systems, you must indicate the programming package and channel name that will be assigned to each receiver. For L-Band systems, all receivers must receive the same programming and no more than six (6) packages may be selected. Premier cannot be used for L-Band installations. If headend, only smartbox, 311, ViP 211(K), ViP 222(K) will be authorized. Up to two (2) 722(K)s may be authorized if used for SLING Remote Monitoring only. If using dual-tuner receivers with the Premier package, italicized and non-italicized channels (as indicated on the Rate Card) cannot be put together on the same receiver. Only two italicized channels or two non-italicized channels can be put on the same dual-tuner receiver. If you have more receivers to list, please attach additional spreadsheets. Receiver Number Smart Card Number Model No. Package Channel Add/Remove 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 6/16/2015 *“DISH Network” and “DISH” are trademarks of DISH Network L.L.C. For purposes of this Activation Form, “DISH Network”, and “DISH” shall mean DISH Network L.L.C. Initial: Operator_____ EQUIPMENT INSTRUCTIONS Add All Remove All Clear All Please complete this page if you are activating a new bulk account or adding or removing receivers to an existing bulk account. For SMATV (head end) systems, you must indicate the programming package and channel name that will be assigned to each receiver. For L-Band systems, all receivers must receive the same programming and no more than six (6) packages may be selected. Premier cannot be used for L-Band installations. If headend, only smartbox, 311, ViP 211(K), ViP 222(K) will be authorized. Up to two (2) 722(K)s may be authorized if used for SLING Remote Monitoring only. If using dual-tuner receivers with the Premier package, italicized and non-italicized channels (as indicated on the Rate Card) cannot be put together on the same receiver. Only two italicized channels or two non-italicized channels can be put on the same dual-tuner receiver. If you have more receivers to list, please attach additional spreadsheets. Receiver Number Smart Card Number Model No. Package Channel Add/Remove 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 6/16/2015 *“DISH Network” and “DISH” are trademarks of DISH Network L.L.C. For purposes of this Activation Form, “DISH Network”, and “DISH” shall mean DISH Network L.L.C. Initial: Operator_____
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