FTTH Construction Approval Form v1

Cordova Telecom Cooperative Fiber-To-The-Home (FTTH)

Customer Approval Form
Owner Name(s)
Property Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Owner Phone
Owner Email
example@example.com
Construction Notes:
Example: Please dig along left side of flower beds.
I approve of bringing fiber into my building unit(s)
Customer Consent

By signing below, I agree that: (a) Cordova Telecom Cooperative (CTC) and their vendors may proceed with construction and any necessary surveys on the property addresses identified to deploy the materials and equipment necessary for delivering broadband Internet services via fiber optics; (b) / will not domage or remove any CTC materials or equipment; (c) / will provide access to CTC to operate and maintain the materials and equipment; and (d) / have the authority to agree to these terms.
Date

MonthDayYear
Date
Customer Signature

Clear
Do you have multiple building units?

YesNo

If you have multiple building units, please list all the approved locations for Fiber-To-The-Home. A CTC representative will contact you to discuss construction details per lot and scheduling.
Multiple Address List

Cordova Telecom Cooperative Fiber-To-The-Home (FTTH)