Authorization Form

Questions? Please contact Distribution Technology at 404-827-2458 or hotline@warnermedia.com

Section 1.

Launch Date * A valid date is required (yyyy-mm-dd).

Test Date * A valid date is required (yyyy-mm-dd).

Section 3.

Distributor Name * This field is required.

Business Name *

Address *

City *

State/Province *

Zip *

Phone *

Fax

Section 4.

System Manager * This field is required.

Phone * This field is required.

Email * This field is required.

Section 5.

Headend Address * This field is required.

City *

State/Province *

Zip *

Phone *

Fax

Website

Section 6.

Headend Manager * This field is required.

Phone * This field is required.

Email * This field is required.

NOC 24x7 Phone * This field is required.

NOC 24x7 Email * This field is required.

Section 7.

Encoding/Format Type *

Please specify * This field is required.

Set Top Box Manufacturer/Model * This field is required.

Integrated Scrambling Technology * This field is required.

Are you providing any WBD Networks to other systems?* Yes No

Please specify * This field is required.

Are you receiving any WBD Networks from other systems?* Yes No

Please specify * This field is required.

Section 8. All Communities/Counties Served

All Communities/Counties Served *This field is required.

Section 10.

Submitted By * This field is required.

Phone * This field is required.

Email * This field is required.

Date A valid date is required (yyyy-mm-dd).

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Tech Info

Authorization Form

Section 1.

Section 2.

Section 3.

Section 4.

Section 5.

Section 6.

Section 7.

Section 8. All Communities/Counties Served

Section 9. Please select network to activate

Section 10.