Pass Word, Inc. | Dig Ticket Registration

DIG TICKET REGISTRATION Please fill out the information below. In addition you must check the box below stating that you agree to the terms below and sign it by typing your name and date.
COMPANY INFORMATION
Company Name:
Contractor ID#:
Company Phone:
Company Fax:
Address 1:
Address 2:
City:
State:		Zip:
Email:
Contact Person:
Contact Phone:
Alternate Contact:
Alternate Phone:
DISCLAIMER Pass Word has until 5:00 PM to enter this request, provided Pass Word received it by 1:00 PM on the day it was submitted. (Monday - Friday, excluding weekends and holidays). If Pass Word receives your request after 1:00 PM, we have until 8:00 AM the following day (Monday - Friday, excluding weekends and holidays) to enter the ticket. I agree and understand my 2 business day notification starts on the above times. The underground facility owners listed on your ticket copy should have their facilities marked by the "Work to Begin Date". I agree I will submit normal routine locate requests(at least 2 business days and no more than 10 business days from planned excavation). I further agree to hold Pass Word free from all liability due to lost or misdirected e-mail requests.
Yes, I understand and agree to the above disclaimer.
Typed Signature: Date:

DIG TICKET REGISTRATION