CTV Enrollment Form CTV Enroll or Disenroll Fom Fill out this form if you would like to be billed for receiving CTV signal or to disenroll if you no longer use our CTV service. CTV Enroll or Disenroll Fom Name Email Phone Address City/Town State/Province - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon ZIP/Postal Code BCREA Account Number Charges Non-member Annual Charge ($96/year) Non-member Non-member Seasonal Charge ($48/year) Non-member Monthly Charge ($8/month) BCREA Members ONLY Billed on monthly electric statement. Remove CTV Charge Other… Enter other… Authorization By submitting this form you are agreeing that this constitutes as your electronic signature and has the same legal validity and effect as your handwritten signature on the document, and that it has the same meaning as your handwritten signature. Please check the box to agree. Date
