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Rogers Letter Permission Form
Communications to:
1. Install, maintain, repair and remove one customer service enclosure (splice box).
Yes / No
(Please circle one)
2. Drill ____ hole(s) for the installation of Rogers services.
Yes / No
(Please circle one)
Choose one:
1. Signature __________________________________
Registered owner
Date _____ /_____ /_____
(dd/mm/yy)
2. _______________________, authorized agent on behalf of the registered owner.
Name
Signature ______________________________________
I have the authority...
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