EMPOWER Broadband Fiber Drop Permission
Please fill out this form completely. A Customer Care Specialist will contact you to verify the information. Please be advised, if we are unable to contact you to verify the installation appointment, we will not be able to move forward with your install.
Please select the CSS you spoke with
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Amy C
Angie T
Connie C
I did not speak with anyone
Joni E
Account #
Phone #
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Your Name
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First Name
Last Name
Contact #
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Area Code
Phone Number
Service Address
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Street Address
Street Address Line 2
City
State
Zip Code
Mailing Address
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Street Address
Street Address Line 2
City
State
Zip Code
Subdivision or Neighborhood
E-mail Address (best contact)
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EMPOWER Broadband Fiber Drop permission please mark all boxes as giving your consent.
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I give my permission to EMPOWER Broadband to install Fiber Optics and Fiber Optic Equipment at my EMPOWER Broadband service address
I understand that a Fiber Optic installation requires a Fiber Optic cable to be trenched from the road to the house, a small box to be mounted on the outside of the home and wire(s) to be run from the box to the inside of the home.
I understand I am responsible for marking and identifying all private underground facilities prior to installation. EMPOWER is not liable for any damages to any underground facilities not properly identified by the Customer.
Please type your full name and the date as giving consent to install the fiber drop at your Service address.
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Signature
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