Schedule an Installation
Full Name: *
Subscriber Phone: ( ) - (include area code)*
Alternate Phone: ( ) - (include area code)
Email: *
Street Address: *
City: *
State (US only): Select State Alabama (US) Arizona (US) Arkansas (US) California (US) Colorado (US) Connecticut (US) Delaware (US) District of Columbia (US) Florida (US) Georgia (US) Idaho (US) Illinois (US) Indiana (US) Iowa (US) Kansas (US) Kentucky (US) Louisiana (US) Maine (US) Maryland (US) Massachusetts (US) Michigan (US) Minnesota (US) Mississippi (US) Missouri (US) Montana (US) Nebraska (US) Nevada (US) New Hampshire (US) New Jersey (US) New Mexico (US) New York (US) North Carolina (US) North Dakota (US) Ohio (US) Oklahoma (US) Oregon (US) Pennsylvania (US) Rhode Island (US) South Carolina (US) South Dakota (US) Tennessee (US) Texas (US) Utah (US) Vermont (US) Virginia (US) Washington (US) West Virginia (US) Wisconsin (US) Wyoming (US) *
Postal Code: *
Same as Subscriber Information.
First Name:
Street Address:
City:
State (US only): Select State Alabama (US) Arizona (US) Arkansas (US) California (US) Colorado (US) Connecticut (US) Delaware (US) District of Columbia (US) Florida (US) Georgia (US) Idaho (US) Illinois (US) Indiana (US) Iowa (US) Kansas (US) Kentucky (US) Louisiana (US) Maine (US) Maryland (US) Massachusetts (US) Michigan (US) Minnesota (US) Mississippi (US) Missouri (US) Montana (US) Nebraska (US) Nevada (US) New Hampshire (US) New Jersey (US) New Mexico (US) New York (US) North Carolina (US) North Dakota (US) Ohio (US) Oklahoma (US) Oregon (US) Pennsylvania (US) Rhode Island (US) South Carolina (US) South Dakota (US) Tennessee (US) Texas (US) Utah (US) Vermont (US) Virginia (US) Washington (US) West Virginia (US) Wisconsin (US) Wyoming (US)
Postal Code:
Home Phone: ( ) - (include area code)
Do you own your own home? Yes No * If no, you must have written approval from the owner at the time of installation.
Preferred Installation Day/Time: First Available Sunday 8am - 12pm Sunday 12pm - 5pm Monday 8am - 12pm Monday 12pm - 5pm Tuesday 8am - 12pm Tuesday 12pm - 5pm Wednesday 8am - 12pm Wednesday 12pm - 5pm Thursday 8am - 12pm Thursday 12pm - 5pm Friday 8am - 12pm Friday 12pm - 5pm Saturday 8am - 12pm Saturday 12pm - 5pm *
Second Choice: First Available Sunday 8am - 12pm Sunday 12pm - 5pm Monday 8am - 12pm Monday 12pm - 5pm Tuesday 8am - 12pm Tuesday 12pm - 5pm Wednesday 8am - 12pm Wednesday 12pm - 5pm Thursday 8am - 12pm Thursday 12pm - 5pm Friday 8am - 12pm Friday 12pm - 5pm Saturday 8am - 12pm Saturday 12pm - 5pm *
Third Choice: First Available Sunday 8am - 12pm Sunday 12pm - 5pm Monday 8am - 12pm Monday 12pm - 5pm Tuesday 8am - 12pm Tuesday 12pm - 5pm Wednesday 8am - 12pm Wednesday 12pm - 5pm Thursday 8am - 12pm Thursday 12pm - 5pm Friday 8am - 12pm Friday 12pm - 5pm Saturday 8am - 12pm Saturday 12pm - 5pm *
BY CLICKING ON THE "SUBMIT ORDER" BUTTON, I HEREBY ACKNOWLEDGE THAT I HAVE READ, I UNDERSTAND, AND I AGREE TO BE BOUND BY KEMPER'S TERMS AND CONDITIONS.
I also understand that Kemper Wireless & Satellite Systems is required to ask for my social security number and credit card information when they call to confirm my Dish Satellite installation appointment. I will have this information ready when a Kemper employee calls me.