DIRECTV Order Form

Rise Tech (866) 228-8669

Your Rep: Ashley Klass

Customer Information

First Name required
Last Name Required
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Must Be In Format XXXXXXXXX
Address Required
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Must be 5 digit zip

Previous Address

Must select yes or no
Address Required
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Must be 5 digit zip

Customer Contact Info

Must be a 10 digit phone number XXX-XXX-XXXX
Must be a valid 10 digit phone number XXX-XXX-XXXX
Must be a valid email address
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Must be a valid date MM/DD/YYYY

Service Information

This field is required.
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1 TV is included, each additional TV is $7/mo
Must select a number

Enroll in autopay for an additional $5/mo discount

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Please double check all information provided is correct to avoid processing delays. After your order is submitted, please be ready for a call from our call center to confirm your order and receive your install date and time.

To the best of your knowledge, you do NOT have a past due bill with AT&T wireless, U-verse or Directv. If you do, you will NOT qualify for service. With permission, you may complete this form with a friend or family members information.


I understand with the submission of this order form I am agreeing to sign up for services. I understand my personal information will not be saved nor shared. All personal information will be used solely to process this order for service. If you agree to the above statement, please sign your name below.