Fiber Drop Permission Request

FIBER DROP PERMISSION REQUEST

Rally customer or not, please fill out this form to have a fiber drop brought to your home. There is no obligation to activate service. The buried fiber drop is available at no cost during construction; installing one later may involve a charge. By completing this form, you are simply keeping your options open for the future so you are never locked into just one provider.

By checking the box on the form, I hereby authorize Rally Networks and its authorized contractors to access the property at the service address below for the purpose of installing a fiber drop to the home/building.

Customer / Property Owner Name:

Primary Phone:

Service Address:

City:

State:

ZIP:

Alternate Contact / Phone:

PERMISSION TO INSTALL FIBER DROP

I authorize Rally Networks and its authorized contractors to access the property at the service address above for the purpose of installing a fiber drop to the home/building. This permission includes the reasonable access and work necessary to place, bury or attach, splice, test, and complete the fiber drop, along with reasonable restoration of areas disturbed by the installation. I confirm that I am the property owner or otherwise authorized to grant permission for this work.

CUSTOMER INSTRUCTIONS / PREFERRED ROUTE

Preferred Contact:

Call Text Email

Best time to contact:

Gate / Access code (if needed):

Permission to Enter Fenced Yard

Yes No N/A

Customer / Property Owner Signature

Date:

Printed Name:

Thank you for helping us bring fiber service to your property.