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DishNetwork Network Feeds Application Form



Here is the form that you can fill out and send to Dish Network that will allow you to receive the broadcast network feeds. Be sure to request all that you want - Fox, ABC, NBC, CBS, PBS. The cost is about an additional $6/month ($1 extra for PBS). Make sure that you meet all the requirements and send in the necessary documentation. You can copy and paste the text into your own word processing program if you wish or click on the link to access an Acrobat Print Ready "PDF" file.


Page 1 of 2

1. Read and Sign Below:


In accordance with the requirements of the Satellite Home Viewer Improvement Act and as a prerequisite for receipt of DISH Network network channel service, I hereby declare and represent the following:

1) that I am the operator of the recreational vehicle or commercial truck for which satellite programming service is requested;

2) that the satellite dish to be used to receive satellite programming is permanently attached to the recreational vehicle or commercial truck referred to in subsection 1) above;

3) that the satellite dish referred to in subsection 2) above will not be used to receive satellite programming at any fixed dwelling, whether a mobile home or otherwise; and

4) that I have attached true and accurate copies of the following documents:

For owners and operators of recreational vehicles: a copy of the current State registration for the recreational vehicle referred to in subsection 1) above.

For owners and operators of commercial trucks: [1] a copy of the current State registration for the commercial truck referred to in subsection 1) above, and [2] a copy of my current valid commercial driver' s license, as defined in regulations of the secretary of Transportation under section 383 of Title 49 of the Code of Federal Regulations.

I am aware of, and acknowledge that, if I wish to receive the aforementioned service for more than two years, at the request of the Network or Networks whose signal is supplied hereunder, I will be required to provide updated information when requested at a future date.




Page 2 of 2

2. Complete the following information:



Phone (as it appears on your account):

3. Choose your network programming. (Maximum 2 Packages)

Circle one or two only of the following cities for the network packages (ABC, CBS, NBC, and FOX) you wish to receive (each package (city) is $4.99/month):

119 Satellite: 110 Satellite:

Los Angeles Atlanta Dallas/Ft. Worth Minneapolis/St. Paul Philadelphia San Francisco

New York Boston Denver Nashville Portland Seattle

Chicago Houston Orlando Sacramento Tampa

Cleveland Kansas City Phoenix St. Louis Washington, DC

Detroit Miami Pittsburgh Salt Lake City

4. Enclose the following documents:

Recreational Vehicle Owners: Include a copy of your current state vehicle registration

Commercial Truck Drivers: Include a copy of your current state vehicle registration; and Include copy of current, valid state commercial driver' s license (CDL)

5. Mail this entire DECLARATION FORM (both pages) and all required paperwork to:


Any incomplete or invalid information will cause a delay or refusal of your request. Please allow 3 to 4 weeks for processing. Upon approval, your programming will be automatically activated and billing for these services will commence at that point.


Or (Even easier) - click on the following link for a Print Ready document:


DishNetwork Network Feeds Application Form Link


Submitted by Mike Sundberg - 2/05/06

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