Kraus Cable TV and Internet Ordering Form

The information provided in this form will only be used by Kraus Online regarding this request for cable TV and Internet services. *Required information.

First Name *

Last Name *

E-mail *

Phone *
###	-	###	-	####

Work Phone
###	-	###	-	####

Street Address

City

State

Zip

Place of Employment

Work Contact

Work Contact Phone
###	-	###	-	####

Do you own or rent your home?
Own
Rent

If you rent, who is your landlord?

Landlord Phone
###	-	###	-	####

Kraus Cable TV and Internet

Select your new services below. Prices are per month (tax and fees not included). Rates are subject to change.

Preferred Installation Date
MM	/	DD	/	YYYY

Digital Cable TV Package
Chicagoland's Best - $18
Standard Basic - $48
Advanced Digital Basic - $68
Digital Platinum - $110

Digital Premium Movie Channels
Cinemax - $14
Encore/Starz - $14
HBO - $16
Showtime/The Movie Channel - $14
Playboy TV - $16

Internet Package if you subscribe to Kraus Cable TV
Life Line - $10
Basic Surfer - $20
Standard User - $30
Premium User - $40
Pro-Gamer - $50

Internet Only Package if you do not subscribe to Kraus Cable TV
Internet Only Life Line - $18
Internet Only Basic Surfer - $28
Internet Only Standard User - $38
Internet Only Premium User - $48
Internet Only Pro-Gamer - $58

If you selected Internet service, how many e-mail addresses would you like?
0
1
2
3
4
5

Questions