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Do you want top-notch channel selection and service for a price that can't be beat?

Fill out the form below and begin to enjoy the stellar entertainment that Air Cable America provides.

Subscriber Name Social Security #
Email Address: Phone Number:
Service Address: City:
State/Province: Zip Code:
Home Phone Work Phone
Mobile Phone Employer
Reference Names (Please provide two)
Will you help us promote AirCable?: Initials:

Installed

The free months are:

Digi-Boxes Deposit Rate: $75.00

Additional Digi-Box Deposit Rate: $25.00

Installation Charge Cable: Free

Digi-Box - $ 3.95 /ea.

Digi-Boxes Rental limit: (2) Digi-Boxes

 

Digital Signature x_______________ (input name or initials here to demonstrate your written authorization and acceptance of the terms below.

*Terms and Conditions: 3-Year Rate Guarantee as agreed upon on this day of__________, 20______, for a period of 3 years from said date. Subscriber’s signature confirms that the subscriber hereby agrees to the following and acknowledges the installation has been completed to the customer’s satisfaction with owner approval: In accepting these terms and conditions from AirCable America, a digital wireless service company, subscriber (signee), shall grant right of first refusal (“ROFR”) to Company (AirCable America) in instances where competing video provider(s) offer, or purports to offer, any exclusive discounted video pricing offer. In accepting Company’s offer, subscriber also agrees to provide Company (AirCable America) with such offer in writing. In the event the signee (ACA subscriber) does not contact ACA regarding the competitive offer and provide ACA the right of first refusal (“ROFR”), and allow ACA the opportunity to match, beat, or provide a better offer, and the signee (ACA subscriber) decides to switch to the competitors service, then the signee (ACA subscriber) shall be liable to ACA for 4 months of payments at the rate of the last month’s subscribers invoice.
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*I understand that the AirCable smartcards will be provided to me at no cost and is the property of AirCable America. DO NOT REMOVE THE SMARTCARD FROM THE RECEIVER BOX. The card will become void if removed or tampered with and the subscriber will be charged a replacement and reprogramming fee of $15.00 and a re-installation fee of $25.00. Tampering of Cable Smartcards is illegal and will not be tolerated. Violators will be prosecuted.

*Payment terms: All payments are due on the 1st of each month. A grace period of 10 days is granted after which a $5.00 late fee will be charged If you have not paid your bill by the 24th of the month and you owe more then $50 you are subject to be disconnected. and have to pay a $35.00 reconnect fee plus your past due balance to have your service restored All returned checks will be charged a $35.00 fee.

CUSTOMER AGREEMENT-TERMS AND CONDITIONS

NOTICE TO ALL CUSTOMERS: Your signature on the front side of this form indicates that you have read, understood, and agreed to the terms and conditions of this Agreement. READ THIS AGREEMENT IN ITS ENTIRETY BEFORE SIGNING.

TERMS: Except as set forth in any special promotion addressed in an addendum hereto, this Agreement provides for AirCable of Roanoke LLC d.b.a. hereafter known as AirCable AMERICA (ACA) to provide cable service to subscribers on a month-to-month basis.

FEES: If payment is not received by due date, service is subject to interruption. In the event of non-payment ACA will impose a reconnect fee of $35.00. Installation fee and deposits are due and payable upon execution of this Agreement. Except for any charges or fees associates with any Special Promotional Offer, ACA reserves the right to change any rates or charges for any service or equipment provided by ACA upon thirty (30) day written notice to Subscriber.
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EQUIPMENT: Subscriber acknowledges and agrees that all equipment installed on Subscribers premises is, and at all times remains ACA property and Subscriber agrees to allow ACA the right to access the equipment. Subscribers hereby assign use of existing interior cable television wiring to ACA to be used in providing wireless cable service to Subscriber’s home. THIS EQUIPMENT WILL NOT WORK IN OTHER WIRELESS OR CABLE PAY TV SYSTEMS. ACA OFFERS NO WARRANTIES EXPRESS OR

IMPLIED, TO SUBSCRIBER. IF THIS EQUIPMENT IS USED OR MISUSED IN ANY MANNER OTHER THEN THE EXPRESSLY PERMITTED BY ACA. ACA is not liable for any failure of or damage to Subscriber-owned equipment connected to equipment provided by ACA for any reason, including but not limited to power outage, electronic or mechanical failure, fire, flood, lightning, acts of God, or any other cause beyond the reasonable control of ACA.
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RETURN OF EQUIPMENT/DEPOSITS/LIQUIDATED DAMAGES: Upon termination of this Agreement, Subscriber is obligated to return and/or permit reasonable access to ACA employees to remove all equipment provided by ACA in good working order and in reasonable condition, subject to normal wear and tear. Upon such return, Subscriber is entitled to refund where as all payments due are current or his/her deposit. If for any reason at the time of termination of the Agreement, Subscriber does not return ACA’s equipment within three (7) days of termination or make it available for removal by ACA personnel, Subscriber agrees to pay ACA as liquidated damages, for the loss of ACA equipment, the amounts specified in the schedule below.
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Converter: $150) per unit

Remote Contro: ($10) per unit

Antenna/Down Converter: ($200) per antenna system

PROGRAMMING: ACA reserves the right to change the content of programming or the level of services offered at any time, all without notice and without liability to ACA. In the event of such changes, ACA shall use its best efforts to notify Subscriber in advance of same. SERVICE CALLS: ACA shall be responsible to provide personnel and/or technicians to insure proper delivery of uninterrupted services to Subscriber. However, in the event an interruption of service or failure of equipment is due to the actions of Subscriber, including but not limited to abuse or neglect of equipment, movement, of television sets or other equipment, and/or attachment of unauthorized equipment to ACA’s equipment, ACA may charge Subscriber a reasonable service fee base upon the prevailing rate for such service visits.
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RESIDENCE OWNERSHIP: Subscriber represents and warrants that the property and structure on which the installation of wireless TV receiving equipment is being made is owned and/or rented by Subscriber. In the event such property is rented, Subscriber further warrants and represents that Subscriber has obtained all necessary approvals and/or authorization from landlord for the installation of such equipment.
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PERSONAL PRIVACY PROTECTION: ACA will not disclose any personal information regarding Subscriber to any person, entity or government agency without the express prior written consent of Subscriber unless required to do so pursuant to legal process. Unless precluded from doing so by statue or court order. Subscriber will be notified of any such request for information in order to provide Subscriber the opportunity to contest such disclosure in an appropriate judicial or administrative forum. In the event ACA violates Subscribers privacy rights, Subscriber may have a cause of action against ACA pursuant to federal and/or state law.

SEVERABILITY: Should any portion of this Agreement be deemed invalid or unenforceable by a court of competent jurisdiction, the invalid portion of the Agreement shall be deleted and the remaining terms and conditions of the Agreement shall be fully enforceable.

ATTORNEY’S FEES AND VENUE: In the event Subscriber violates this Agreement in any way ACA shall be entitled to reasonable attorney’s fees, collection and court costs. Relevant state law shall apply and govern as to any dispute between Subscriber and ACA, and Subscriber agrees that proper venue is where ACA local office is located.

INDEMNIFICATIONS: Subscriber agrees to indemnify ACA and hold harmless from and against any and all claims, liabilities, losses, or damages of any kind, including reasonable attorneys fees, on account of damage to or loss of property or on account of injury to or death of any person arising from or in connection with the installation, maintenance and removal of ACA equipment on Subscribers premises or the providing by ACA of its programming services, except for such loss or damages caused by the negligence of ACA or its employees.

NO WARRANTIES: ACA makes no warranties, express or implied as to the description, quality, merchantability, fitness for any particular purpose or any other matter, of the service of equipment that ACA shall supply under this Agreement.

ENTIRE AGREEMENT: The terms and conditions of the agreement are between ACA and the Subscriber and may not be modified in any way by verbal claims or statements. This Agreement may only be modified by written agreement between Subscriber and ACA.____________ initial.

Digital Signature x_______________ (input name or initials here to demonstrate your written authorization