Permission to Bury

Name *

First

Last

Cell Phone *

Email *

Service / Mailing Address *

Address Line 1

Address Line 2

City

State

Zip Code

I understand by completing this consent form WST will add buried cable on my property and install an electronic box on the outside or inside of my home. I understand that I may call at a later time to have fiber internet services connected. *

I acknowledge
I disagree

PLEASE SIGN BELOW *

Date *