Permission to Bury Fiber

PERMISSION TO BURY FIBER
We have sent letters to customers who are able to get future service. If you haven’t received a letter and would like to know if you can get service, call 319-276-4458. Please do not complete this form unless you have received either written or verbal confirmation of our request. Continue?*

YesNo
There is NO COST to bring this service to your location. If you do not own this property, please give this form to the owner.

Line Installation Permission Agreement

Butler-Bremer Communications is requesting your permission to bury a fiber line from the public right-of-way to your home or business and place a Network Interface Device (NID) on your structure as part of our construction project to bring Fiber-to-the-Home to your neighborhood. This will allow you, in the future, to have a choice, of Internet, TV & Phone providers.
Property Owner*

First NameLast Name
Address*

Street Address

Street Address Line 2 / PO Box

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Email*

Confirmation Email
I am the property owner of the address above. I grant Butler-Bremer Communications the permission and an easement to bury a line across my property and install a NID on my structure.*
Please type your full name above, which will serve as your signature.
Date*

MonthDayYear
Current Buried Underground Services. PLEASE CHECK THE APPROPRIATE BOX OR BOXES:*

Sprinkler SystemWellSeptic SystemInvisible FencePowerLinesCommunication LinesFoundationsFuel Tanks or CisternsNone of the above
List any other underground services here, or general comments for when we reach your property:
Please send me info about fiber products coming soon to me!
Should be Empty:

PERMISSION TO BURY FIBER