Satellite TV Local Channel Waiver Request Form

Satellite TV Local Channel Waiver Request Form
Submit your request to waive restrictions on local channel access via your satellite TV provider.
Full Name
First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Service Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Satellite TV Provider
Satellite TV Account Number
Local Channel(s) for Waiver Request
Reason for Waiver Request
Have you previously submitted a waiver request for local channels?
Preferred Contact Method
Applicant Signature
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