EMPOWER Property Owner

Letter of Authorization

Communications Service Line Installation for Property Manager/Landlord/ Owner

Communications Service Line Installation for Property Manager/Landlord/Own

FOR CUSTOMERS RENTING OR LEASING - You must obtain the Manager/Landlord/Owner's written authorization for installation prior to the arrival of the EMPOWER Broadband installer to connect fiber to the exterior and interior of the property. Proper installation may require drilling through interior and/or exterior walls and/or floors to run cable and install exterior and interior equipment. Without this written permission, the installation cannot proceed.

Tenant/Resident Name (Please Print)

Street Address/Unit#

City

State

Zip

Tenant/Resident Home Phone Number

Format: (000) 000-0000.

Tenant/Resident Home Phone Number

Format: (000) 000-0000.

MANAGEMENT/LANDLORD/OWNER'S Authorization - As the Manager/Landlord/Owner of the above mentioned property, I (we) represent that I (we) have the authority to sign this Letter of Authorization and hereby do authorize installation of EMPOWER Broadband's equipment and cabling at the above-mentioned address by EMPOWER Broadband or its contractor. I (we) also grant EMPOWER Broadband reasonable access to the property to make modifications or alterations. Manager/Landlord/Owner acknowledges that EMPOWER Broadband is not responsible for the removal of such hardware, nor is EMPOWER Broadband responsible for restoring the property to its original condition upon termination of services.

Owner/Property Manager Name (Please Print)

Mobile Number

Format: (000) 000-0000.

Owner/Property Manager Office/Home Phone Number

Format: (000) 000-0000.

Owner/Property Manager Contact Email

Signature of owner/property manager

Date

For the purpose of this agreement it is understood that by signing this LETTER OF AUTHORIZATION in no way obligates the property owner to accept communication services from EMPOWER Broadband originally contracted by the tenant or lessee. It is further understood that no such interior cabling or installation will take place until a service contract is initiated by the property owner or tenant thereof.

Chase City, VA 23924I(434) 372-6244www.empowermec.net