Drop Only (No Service) Form

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Drop Only (No Service) Form

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* Indicates required question

Email *

Your email

Name: *

Your answer

Service Address: *

Your answer

Cell Phone # *

Your answer

Is it okay to text this number? *

Yes

No

Do you rent or own the premise? *

Rent

Own

If you rent, what is the name and a contact number for your landlord?

Your answer

By checking this box, I am giving permission for Haviland Broadband to put in a free Fiber drop to my premise. I do not want services at this time. *

Drop Approval

Required

Submit

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