FIYAH Registration FIYAH Registration Form Customer Information First Name * Last Name * Address * Address 1 * Address 2 City * Contact Number * Email * CCT Sales Agent Did a sales agent assist you? If so, enter their name here. Date of Birth * MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Year1924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008 Year Pick up device(s) Deliver device(s) Delivery * I hereby accept all Terms and Conditions indicated in this agreement indicating FIYAH and CCT Live. Terms and Conditions * Sign Up Click on any of the plans below to make a selection. Selected Plan * FIYAH GOLD FIYAH SILVER FIYAH BRONZE CCT FIYAH Installation Fee - $99 $199 FIYAH GOLD Up to 900Mbps down/up to 90Mbps up 80+ Channels, Modem, Set Top Box $159 FIYAH SILVER Up to 600Mbps down/up to 60Mbps up 50+ Channels, Modem & Set Top Box $119 FIYAH BRONZE Up to 300Mbps down/up to 30Mbps up 20+ Channels, Modem & Set Top Box Save more when you bundle FIYAH with Freedom options or CCT LIVE. *Basic(+) not included.* Leave this field blank
