Pass Word, Inc. | Send a Dig Ticket

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SEND A DIG TICKET 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:
Phone:
Alternate Phone:
Pager:
Fax:
Email:
Contact Name:
Contact Phone:
Alternate Contact:
Alternate Contact Phone:
Contact Supervisor:
EXCAVATION LOCATION
State:		County:
City:
Water Company:
Address of Dig:
Nearest Intersection:
2nd Nearest Intersection:
Legal Description:
Township:		Range:
Section:		Quarter Section:
EXCAVATION INFORMATION
Type of Work:
Work Being Done For:
Work Start Date:		Start Time:
Direction of Digging:
Dig Instructions:
Length of Digging:
Width of Digging:
Depth of Digging:
EXACT DIG LOCATION
Private Property:		Easement:
Street:		Mechanical Boring:
Overhead Lines:		Premarked:
Blasting:
CONTACT TO CONFIRM OR SETUP
Contact to Arrange Site Meet:
Additional Dig Information:
Remarks:
Header Type:
DISCLAIMER Pass Word has until 5:00 PM to enter this request, provided Pass Word receives 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:

SEND A DIG TICKET