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123 Street Avenue, City Town, 99999

(123) 555-6789

email@address.com

 

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IN811_WETF

Web Ticket Entry Application

This application is not valid unless executed by an authorized individual of Indiana 811. The user will be notified by a representative of Indiana 811, either by E-mail or phone to acknowledge receipt of application and to schedule your training session.

Thank You.

 

If you have not read the Indiana 811 Web User Agreement please Click Here before filling out the application.
 

Name *
Name
Office Phone Number *
Office Phone Number
Cell/Alternate Number
Cell/Alternate Number
Select which type of training you would like (may choose more than one): *
Web Ticket - Create your own normal notice ticket. Design Ticket - Used for planning and survey purposes. Utilities are notified and have 10 full business days to respond by providing the best available description of all buried utility facilities within the designated area. THIS DOES NOT CONSTITUTE A LEGAL LOCATE TICKET. Design Inquiry - Generate a list of contact information for member utilities to be used for advanced planning purposes. THIS DOES NOT CREATE A LOCATE TICKET AND UTILITIES WILL NOT BE NOTIFIED.
Today's Date *
Today's Date
Check below to indicate that you have read and agree to the terms in the Indiana 811 Web User Agreement. *