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 Year1925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009 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
