Connection Request Form

I authorize The Wired Road to provide a connection to the Network at the Business/Residence that I am requesting service at. I also grant permission to The Wired Road’s construction contractor, and other Wired Road agents or assigns, to enter my property for the purpose of constructing and inspecting said Network connection. This permission is predicated on the condition that the construction contractor will restore my property as near to its original condition as is practicable, and that I will cooperate in effectuating such restoration. If the work to be performed is only for installation of a connection to the Network, I am willing to execute a hard copy of this authorization; further work will be addressed by separate agreement(s). In exchange for this Network connection, I hereby agree to purchase service from my choice of service provider(s) on the Wired Road Network, for a period of not less than two (2) years from the date that the construction of the Network connection is completed.