National Satellite Referral Rewards

PROVIDE COMPLETE INFORMATION IN THE FIELDS PROVIDED FOR PROPER DELIVERY

Your Information (Customer #1)

First and Last Name:

Date of Purchase:

HughesNet Account Number:
(as shown on HughesNet invoice)

Installation Address (Street):

City, State, Zip Code:

, ,

Check this box to use same install address as mailing/billing address.

Mailing Address (Street):

City, State, Zip Code:

, ,

Primary Phone Number:

ex. 701-555-1212

Alternate Phone Number:

ex. 701-555-1212

E-Mail Address:

Your Customer Referral (Customer #2)

First and Last Name:

Date of Purchase:

Installation Address (Street):

City, State, Zip Code:

, ,

Primary Phone Number:

ex. 701-555-1212

Alternate Phone Number:

ex. 701-555-1212

E-Mail Address:

Comments:

I certify that the information I have entered on this form is accurate and complete.

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National Satellite is an authorized dealer of HughesNet services and Hughes products available in the contiguous United States. Equipment requires professional installation. HughesNet service may be sold separately from hardware. The HughesNet service is subject to the Fair Access Policy and speeds may vary. HughesNet is a registered trademark of Hughes Network Services, LLC. All rights reserved. For more information, please visit legal.hughesnet.com.

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