Sales Order Entry Form
Section 1: Customer Information
Property Name
Unit Number
First Name
Last Name
Home Phone
Alternate Phone
Service Address
City
State
Zip
Billing Address
City
State
Zip
Section 2: Services
DirecTV
HD Access
HD Extra Pack
DVR Services
Private Cable
Private Cable Service in not currently available to all locations. Please check with our representative.
ISP
ISP Service in not currently available to all locations. Please check with our representative.
VoIP
VoIP in not currently available to all locations. Please check with our representative.
Section 3: Scheduled Installation
Requested Installation Date:
January
February
March
April
May
June
July
August
September
October
November
December
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
2010
2011
2012
AM
PM
Section 4: How did you hear about MDU CommunIcations?
Call MDU @ 1.866.941.6912 or
click here
to receive more information.
