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info icon Apply for DISH services here, with one secure form. Submit this form and your DISH TV qualification results will appear instantly on the next screen.
First Name
Last Name
Primary Phone Number - -
Secondary Phone Number - -
Service Address Line (1)
(No P.O. Boxes.)
Street Address Line (2)
(examples: apt, unit, lot)
City
State
Zip Code (Five digits)
Do you own the residence?
Is your billing address the same?
Email Address
You get a confirmation email.
Order Notes
info iconDISH requires your date of birth and social in order to qualify you for service. This form is encrypted (SSL/HTTPS) for security purposes. Your information is private and secure.
Date of Birth / /
Social Security Number - -
This form is secure.
What is the answer to 5 + 1?
The answer is 6. Sorry for asking! This question prevents SPAM.
info iconCheck the terms and conditions box, then click the submit button, and you will be contact within 5 minutes (during our business hours). Clicking the submit button will display a review for you.
I have read, accept, and understand the Terms & Conditions
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