PTB AREA INSTALL AGREEMENT

Agreement needed prior to installation of fiber to the premises by JPUD in the Port Townsend Business Fiber Project Area.

Name(Required)

First Last

Email(Required)

Service Address(Required)

address of location where fiber is to be installed by JPUD.

Street Address City

Billing Address

Is the service address the same as the address where we should send the bills?

Yes

Billing Address

Please enter the address to which we should send any bills for installment payments

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Line Extension Payment Options(Required)

Select one. The fiber installation line extension charge for the Port Townsend Business Project is $1200. Installments are available in monthly payments over 36 months. Fiber Line extension installation payments must be paid in entirety regardless if customer is using the service.

Pay In Full Upfront $1200

Down Payment + Installments

Down Payment Amount(Required)

Please list down payment amount. Minimum amount is $100. Remaining installments will be billed monthly until balance is paid in full.

Payment Method Preference(Required)

Select one. Customer service will send an email with a link to pay online if SmartHub option chose. Checks can be mailed to Jefferson County PUD, 310 Four Corners Rd, Port Townsend WA, 98368. This is also the location of our Customer Service Center, which is open M-F 9am to 4:30pm. Work cannot begin until payment is received.

Pay Online via SmartHub

Mail Check

Pay in Person at 310 Four Corners Office

Consent to Terms of Installation Agreement(Required)

By signing this agreement, you warrant that you are either the owner of the property (“Premises") or that you have the authority to give Jefferson County PUD ("JPUD") access to the Premises. If you are not the owner of the Premises, you are responsible for obtaining any necessary approval from the owner to allow JPUD and its agents access to the Premises to perform the activities specified above. You are hereby granting JPUD and its agents the right to enter the Premises at which the fiber optic telecommunications services and/or equipment (“Service(s)”) will be connected at reasonable times, for purposes of installing, configuring, maintaining, inspecting, upgrading, replacing and removing the Service(s) and/or equipment used to receive any of the Service(s). Equipment and fiber optic cable installed at the Premises remains property of JPUD. Removal or damage of equipment will result in replacement charges to the resident not to exceed$300. Customer agrees to indemnify and hold harmless JPUD from any and all damages or claims resulting from installation of the equipment to customer's Premises. Customer further agrees to waive any claims to incidental or consequential damages and agrees that the liability of JPUD shall be limited to the cost of installation. The Customer shall protect, defend, indemnify, and hold harmless JPUD, its officers, officials, employees, agents, and volunteers from any and all claims, risks, injuries, damages, losses, suits, judgments, and attorney’s fees or other expenses of any kind arising out of or in any way connected with the performance of this agreement. Customer’s indemnity obligations hereunder do not extend to liability resulting from the gross negligence of JPUD, its agents, or employees.

Line extension installment payments are available in monthly payments over 36 months. Fiber Line extension installation payments must be paid in entirety regardless if customer is using the service.

I have read, understand, accept, and agree to the terms of this connection order agreement. All changes must be in writing. Any changes may result in a new installation date and additional charges. The above connection installation charge includes all taxes, fees, or surcharges applicable to the installation. This agreement does not include retail service provided over the fiber optic connection.

for Customer Service Only: W.O. #322050

I have read and agree to the terms of this agreement.

Signature(Required)

Name

This field is for validation purposes and should be left unchanged.