Channel 1 Communications ® 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:_____________________________

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Service Purchased:______________________________________  Monthly Rate:____________

Set-up Charge:_________________              Standard Monthly Billing Cycle from the 1st to 31st

Equipment Leased:______________________________________

Other Notes:________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

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-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

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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: admin@channel1.com


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