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2. Service Location of Address being Sold:*
3. City:*
5. Date of sale range:*
   Date of sale range: Start Date

   —

   Date of sale range: End Date
9. Name(s):*
10. Email Address
12. Forwarding Address:*
13. City:*
15. State:*
16. Zip Code:*
17. Phone Number:*
21. Dumpster/Drop Box*

    1. No, I do not have a dumpster
    2. Yes, I have a dumpster

    *If you have a dumpster or drop box at this location, please call to have it hauled. These fees may not be on your closing bill but will be due by you for the service provided.*
22. Organics Remove:*

    1. Please remove organics
    2. Keep organics at location
    3. Not applicable
23. Fiber Optics - Access Anacortes

    I have Fiber at this location and would like to:

    1. Terminate Fiber
    2. New owner wants to keep Fiber
25. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
27. Electronic Signature*
28. Date:*
    Date:
Leave This Blank:


30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit

* indicates a required field