FIBER OPTIC OPT-IN CERTIFICATE

1. That Owner is the owner of that certain property identified below and has the power and authority to execute this Certificate.

2. That Owner desire to be benefitted by the Improvements and hereby grants Fybercom permission to install a fiber optic drop cable, and other fiber optic equipment at the address listed below and to access Owner’s property for installation and future maintenance of Owners fiber optic line.

3. That Owner acknowledges and understands that there are a number of legal and practical steps that the Fybercom must complete before Owner’s property can receive a fiber optic line, and therefore that Owner’s execution of this Certificate does not guarantee that Fybercom will be able to create Fiber or that the Improvements will be constructed and installed.