EHtel/BT Fibre Installation Consent Form

I hereby acknowledge that Bruce Telecom, or the contractors acting on behalf of Bruce Telecom, will be burying fibre optic cable from the road allowance to a demarcation point on my dwelling. Any disturbance to the landscape will be repaired by the contractor. I acknowledge that Bruce Telecom will be installing a Network Interface Device (NID) in my premises to connect the fibre optic cable to my inside wire. If you’d like to send us a drawing of what’s in your yard, please email it to consentforms@brucetelecom.com.

Address(Required)

Street Address Address Line 2 City Province Postal Code Country

Is this your Primary Mailing address? If no, please specify.

Yes

Address(Required)

Street Address Address Line 2 City Province Postal Code Country

Name(Required)

First Last

Email(Required)

Primary Phone(Required)

Alternate Phone

Rent or Own?(Required)

Name of Property Owner(Required)

Property Owner Phone

Property Owner Email

Do you have anything in the ground that would not be captured with utility locates? Ex. underground sprinkler system, septic system, electronic fencing.(Required)

Please elaborate on what it is and where specifically on the property it is located.

Please let us know the approximate location of the hydro metre and the electrical panel in your home. Which side of the house will work.(Required)

Is there anything in the ground within 5 feet of either side of your driveway? If yes, please provide details

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EHtel/BT Fibre Installation Consent Form

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