Tell us more about the property
I affirm that I am the owner of the property shown above and that I have legal authority to grant access to the property.
Yes
No
I grant Anthem Broadband, its contractors, and employees access to the property for the purpose of installing a fiber internet connection and future access for repair and maintenance of said connection.
For the installation of new services where an existing fiber internet connection does not exist, please indicate which location on the house you would most like the connection point to be made. The connection will consist of a small box (NID) placed on the side of the house. From there, the fiber line will be connected to the service line (most often by the road or alley) and a second connection will be pulled from the NID through the wall to be connected to the router. (click here to learn more)
Please note that we will do our best to abide by your request but may have to make alterations based on terrain and other obstacles. If any changes are made, we will contact you in advance to discuss the changes and any options you may have.
To the best of my knowledge, the information I have provided is true and correct and I agree to be bound to the terms as outlined in this agreement.
By selecting the "I Accept" button and typing your name below, you agree that you are signing this Agreement electronically. Each party agrees that the electronic signatures, whether digital or encrypted, of the parties included in this Agreement are intended to authenticate this writing and to have the same force and effect as manual signatures. Electronic signature means any electronic writing, symbol, or process attached to or logically associated with a record and executed and adopted by a party with the intent to sign such record, including email electronic signatures."
I Accept
Customer Signature:
What email address would you like us to send a copy of this agreement to?
