I, (fill in full name below) have requested that Panora Fiber provide services to the structure located at (fill in street address below).
This structure will be untenanted or empty for all or part of the time the technician provides such services. I have provided Panora Fiber with any available information relating to hazardous circumstances which may be present in the dwelling. I further waive any right to assert a claim against Panora Fiber for damages resulting from the technician's presence in the property.