I, _______________________ make this declaration under the penalties of perjury under the laws of the United States and the state where I live. I affirm that all the statements in this declaration are true and correct.

I acknowledge that DIRECT TV, Inc. ("DirectTV") requires that all DIRECTV System receivers be continuously connected to the same land-based telephone line and that this requirement is set forth in paragraph 1(g) of the DIRECTV Customer agreement, affective October 1999. I understand that one of the purposes of this requirement is to ensure that all receivers tied to one account are all actually located at the same address.

I also understand that, notwithstanding paragraph 1(g) of the Customer Agreement DIRECTV has agreed to charge me the Additional Receiver Authorization fee, currently $4.99 per month, for each additional receiver at my home, even though the additional receivers are not connected to the same land based telephone line.

I acknowledge that, in agreeing to this billing arrangement, DIRECTV is relying on my representation that all receivers tied to my DIRECTV account are currently located, and will continue to be located, in my home, boat, or recreational vehicle.

___________________________

Signature

Date: ______________________

Name: ______________________

Address: _____________________, _____________, _______

DIRECTV Account #:

Number of DSS Receivers at this address: ___________

KVH MODEL: __________________________________

KVH Serial #: __________________________________