Property Authorization and Interest Form
This form is used to collect the information we need to install a buried wire to your home or business. It helps us plan work safely by confirming details (i.e., address, contact information, and any special conditions, etc.) on your property.
Are you a member of a First Nation?
*
Please Select
Yes
No
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Do you authorize the installation team to complete the buried service work on your property?
*
Please Select
Yes
No
Full Name
*
First Name
Last Name
Address of Residence or Cottage
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Upload a Photo of your Property
If you would like to provide a photo of your property, this is helpful to our team to understand the layout and prepare for the work. You can also provide additional details specific to your property.
Image Upload
Browse Files
Drag and drop files here
Choose a file
A front yard, driveway, or side view of the home is usually the best.
Cancel
of
Please select any potential obstacles that may be on your property. Use the text box below to provide more detail on the obstacles.
Water
Sanitary
Lawn Sprinklers
Propane/Gas Line
Private Hydro
Other
None
Please provide additional details on the obstacles if applicable:
Examples: Pets, Secured Fences, Hydro Lines, etc.
Would you like to sign up for Broadband North services when it is available in your area?
*
Yes
No
Please select the services you would be interested in.
Internet
TV
Home Phone
Acknowledgment & Approval
I authorize the installation team to complete the buried service work on my property as described.
*
Please Select
Yes
No
Name
*
First Name
Last Name
Signature
*
Save
Submit
Should be Empty: