Sales – Ender Your Order Here

KR Communications Sales Form

Step 1 of 2

Sales Representative*
First Last
Company Name

Company Name
Sales Representative Territory*

Territory
Sales Representative Email*

example@example.com
Sales Representative Phone Number*
(###) ###-####
Type of Sale*
- Residential Sale
- Commercial Sale

Customer Name*
First Last
Customer Phone Number*
(###) ###-####
Alternate Phone Number
(###) ###-####
Address*
Street Address Address Line 2 City State ZIP Code
Customer Email*

example@example.com
Customer Credit Card/Debt Card Number*
Customer Credit Card/Debt Card Expiration Date*

XX-XX
Customer Credit Card/Debt Card CVC*
Attach Additional Documentation (if needed)
Drop files here or

Accepted file types: jpg, jpeg, png, pdf, gif, tiff, Max. file size: 15 MB.
Service*
- DIRECTV
- AT&T Mobility
- Viasat
- DIRECTV Stream
- ADT
- Spectrum
- Frontier
- Windstream
- CenturyLink
- AT&T Broadband
Social Security Number*
Date of Birth*
MM slash DD slash YYYY

Date of Birth
DIRECTV Package*
- Entertainment
- Choice
- Ultimate
- Premier
Equipment
Equipment
Equipment
Equipment
Equipment
Equipment
Number of TV's*
Driver License/ID Number*
Driver License/ID State Issued*
Driver License/ID Exp. Date*
MM slash DD slash YYYY
Data Package*
Data Package*

NON UNLIMITED PACKAGE
Upgrade Frequency*
Number of Lines*
1st Device*

Make - Model - GB Size - Color
1st Device Porting Number?*
- Yes
- No
1st Device Porting Phone Number*
1st Device BOYD (Bring Your Own Device)*
- Yes
- No
1st Device IMEI Number*
2nd Device*

Make - Model - GB Size - Color
2nd Device Porting Number?*
- Yes
- No
2nd Device Porting Phone Number*
2nd Device BOYD (Bring Your Own Device)*
- Yes
- No
2nd Device IMEI Number*
3rd Device*

Make - Model - GB Size - Color
3rd Device Porting Number?*
- Yes
- No
3rd Device Porting Phone Number*
3rd Device BOYD (Bring Your Own Device)*
- Yes
- No
3rd Device IMEI Number*
4th Device*

Make - Model - GB Size - Color
4th Device Porting Number?*
- Yes
- No
4th Device Porting Phone Number*
4th Device BOYD (Bring Your Own Device)*
- Yes
- No
4th Device IMEI Number*
5th Device*

Make - Model - GB Size - Color
5th Device Porting Number?*
- Yes
- No
5th Device Porting Phone Number*
5th Device BOYD (Bring Your Own Device)*
- Yes
- No
5th Device IMEI Number*
6th Device*

Make - Model - GB Size - Color
6th Device Porting Number?*
- Yes
- No
6th Device Porting Phone Number*
6th Device BOYD (Bring Your Own Device)*
- Yes
- No
6th Device IMEI Number*
7th Device*

Make - Model - GB Size - Color
7th Device Porting Number?*
- Yes
- No
7th Device Porting Phone Number*
7th Device BOYD (Bring Your Own Device)*
- Yes
- No
7th Device IMEI Number*
8th Device*

Make - Model - GB Size - Color
8th Device Porting Number?*
- Yes
- No
8th Device Porting Phone Number*
8th Device BOYD (Bring Your Own Device)*
- Yes
- No
8th Device IMEI Number*
9th Device*

Make - Model - GB Size - Color
9th Device Porting Number?*
- Yes
- No
9th Device Porting Phone Number*
9th Device BOYD (Bring Your Own Device)*
- Yes
- No
9th Device IMEI Number*
10th Device*

Make - Model - GB Size - Color
10th Device Porting Number?*
- Yes
- No
10th Device Porting Phone Number*
10th Device BOYD (Bring Your Own Device)*
- Yes
- No
10th Device IMEI Number*
Previous Wireless Company Name*
Previous Wireless Company Account Number*
Previous Wireless Company Account Pin*
Does Customer Have DIRECTV*
DIRECTV Account Number*
Viasat Zip Code Look up
(Viasat) Data Package*
(Viasat) Unlisted Package*
(Viasat) Internet Speeds (Mbps)*
AT&T U-verse Availability
Internet Speeds (Mbps)*
DIRECTV Stream Packages*
- Entertainment
- Choice
- Ulitmate
- Premier
Number of Boxes*
- 1 ($10 for 12 Months for Well-Qualified People- Other Pay $120 Upfront each Box)
- 2 ($10 for 12 Months for Well-Qualified People- Other Pay $120 Upfront Each Box)
- 3 ($10 for 12 Months for Well-Qualified People- Other Pay $120 Upfront Each Box)
- 4 ($10 for 12 Months for Well-Qualified People- Other Pay $120 Upfront Each Box)
Business Name*
Business Contact Name*
First Last
Business Contact Email*
Business Phone Number*
Business Service Address*
Street Address Address Line 2 City State ZIP Code
Is Billing Address Same as Service Address?*
- Yes
- No
Business Billing Address*
Street Address Address Line 2 City State ZIP Code
Customer Credit Card/Debt Card Number*

XXXX-XXXX-XXXX-XXXX
Customer Credit Card/Debt Card Expiration Date

XX-XX
Customer Credit Card/Debt Card CVC*

XXX
Auto-Pay*
- Yes
- No
Tax ID*
Type Of Viewing*
- Public - any business that serves food and/or drinks (bars, restaurants, coffee shops)
- Business - businesses that do not serve food or drinks and have TVs accessible to their customers (gyms, salons, waiting areas, auto shops)
Number of TVs*
Estimated Viewing Occupancy*
Please enter a number greater than or equal to 1.
Public Viewing Package*
- Business Select Pack
- Commercial Entertainment Pack
- Commercial Xtra Pack
Public Viewing Package*
- Business Select Pack
- Commercial Choice Pack
- Commercial Choice Plus Pack
Business Viewing Package*
- Business Select Pack
- Business Enterainment Pack
- Business Xtra Pack
Does the Building Have a Flat Roof?*
- No
- Yes (a non-penetrating roof mount will be required for installation- there is an upfront fee of $100 for this)
Would They Like Any Sports Packages?*
- Yes
- No
Fire Code Occupancy*
Please enter a number greater than or equal to 1.
**The customer will be required to submit an approved Fire Code Occupancy certificate to DIRECTV prior to the activation of any premium sports package
Attach Fire Code Occupancy Certificate*
Accepted file types: iejpg, gif, png, pdf, Max. file size: 2 MB.
ADT Packages*
- Traditional (Activation Fee $99)
- Traditional w/ Life Safety (Activation Fee $99)
- Remote (Activation Fee $99)
- Video Lite (Activation Fee $99)
- Control (Activation Fee $99)
- Video Lite & Control (Activation Fee $199)
ADDITIONAL EQUIPMENT
Spectrum
- Select All
- TV
- Internet
- Home Phone
Spectrum TV Packages*
Spectrum Internet Speed*
Spectrum Home Phone*
- New Number
- Porting Number
Home Phone Porting Number*
Current Company Porting Number Name*
Current Company Porting Number Account Number*
Windstream Internet Speed*
Comcast/Xfinity
- Select All
- TV
- Internet
- Home Phone
Comcast/Xfinity TV Packages*
Comcast/Xfinity Internet Speed*
Comcast/Xfinity Home Phone*
- New Number
- Porting Number
Home Phone Porting Number*
Current Company Porting Number Name*
Current Company Porting Number Account Number*
Alder Packaging*
Additional Equipment & Pricing
- Motion Detector ($2 additional monthly)
- Smoke Detector ($2 additional monthly)
- Glass Break Detector ($2 additional monthly)
- Door/Window Sensor ($1 additional monthly)
- Key Fob ($1 additional monthly)
- Medical Pendant ($1 additional monthly)
- Outdoor Camera ($4 additional monthly plus $50 on activation)
- Indoor Camera ($2 additional monthly plus $25 on activation)
Frontier Internet Plans*
Basic Internet & Interent*
FiberOptic*
Internet Fixed Wireless*
Does Your Customer Want Frontier TV*
- Yes
- No
Frontier TV*
Whole Home DVR*
- Yes
- No
Set-Top Boxes Needed*
Notes/Comments
Email
This field is for validation purposes and should be left unchanged.