Fiber Project Intake Form

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Fiber Project Intake Form

Fiber Project Intake Form

Customer Name:

Customer Location:

Customer Contact:

Customer Contact #:

Customer Contact Email:

Project Serving Area:

Project Start:

Project End:

Project Budget:

Project Budget (per home passed):

Technology/OLT (GPON/XGS PON):

Preferred OLT Manufacturer (ADTRAN/CALIX/DZSi/Cambium):

Placing Method (Aerial/Buried/Underground):

Preferred OSP Placing Contractor Name:

Preferred OSP Placing Contractor Contact:

Preferred OSP Placing Contractor Contact #:

Preferred OSP Placing Contractor Contact Email:

Pole Owner:

Joint Use Agreement Existing (Yes/No):

Existing Residential Customers in Area:

Projected Take Rate:

Existing Residential Customers in Area:

Targeted Residential Sub Count:

Projected Take Rate:

Distance from the AP to the farthest away SM

Project Description:

Additional Notes:

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