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Customer Agreement

Note: If you do not have a Channel 1 Account, please go to our Channel 1 SignUp Agreement.

Customer Name:   ______________________________________     Phone #:________________
Billing Address: ______________________________________ Fax: ________________
______________________________________ E-Mail: ________________
Contact Person: ______________________________________

Payment Method:
Visa: M.C.: Card Holder Name:__________________________________
Amex: Discover: Card Number:_______________________________________
Invoice: P.O. Number: Card Holder Signature:_____________________________
Service Purchased:______________________________________ Monthly Rate:____________
Set-up Charge:_________________ Standard Monthly Billing Cycle from the 1st to 31st
Equipment Leased:______________________________________
Other Notes:________________________________________________________________________
-Monthly billing (or charge) will be issued during the first week of the month for that month, plus initial pro-rated month and set-up charge if applicable. -Payment will be due upon receipt of invoice. -Channel 1 will try to provide at least 30 days notice of termination, except in cases of overdue payments. -Account may require re-enable fee if payment is not recieved by the end of the current month. -Cancellation requests received by Channel 1 in writing of fax, during the month will become effective at the start of the next billing cycle.

______________________________________ ______________________________________ Signature of Authorization Signature of Authorization of Channel 1 ®
______________________________________ ______________________________________ Print Name and Tilte Print Name and Title
______________________________________ ______________________________________ Date Date
Please print out and complete a copy of this Customer Agreement, and then mail or fax it to:
Channel 1 Communications, 14 Arrow Street, Cambridge, MA 02138
Fax: 617-354-3100 Phone: 617-864-0100 E-Mail:

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