Cable TV Service Application


Customer Information
Customer Name
Service Address
City
State
ZIP
County
Daytime Phone
Cellular Phone
Email address
Billing Address
Social Security #
Drivers License #
Account Password (To verify account information)
Date Service is Requested

Available Cable TV Services

Basic Cable TV
Premium Movie Channels
Digital Package
HBO
High Definition Package
Showtime
Digital Video Recorder (DVR)
Cinemax
High Speed Internet / Cable Modem Encore / Starz  

In order to provide Cable TV Service to subscribers, it is my understanding that I will be allowing Cable TV facilities and personnel on my property if owned by myself, or will get approval from the owner.

I agree that any leased equipment is the property of the Cable Company, shall be subject to monthly rental charges, and shall be returned upon termination of service in good working condition.

In making this application, I agree to pay the bill in a timely manner and follow the rules and regulations as established by Northwest Communications or its subsidiary. All prices are subject to change.


Customer Signature __________________________________

Date __________


Northwest Communications
120 Birch St W
Amery, WI 54001