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2. Date Request Submitted
   Date Request Submitted
3. Requested Delivery Date*
   Requested Delivery Date
5. Requestor's Information
7. Name*
8. Company
9. Department/Location
11. Main Phone Number*
12. Cell Phone Number
13. Email Address*
15. Please select the appropriate box for the priority of your data request. *

    1. 1. This request is critical to receive as close as possible to the requested delivery date
    2. 2. This request is important to be completed by requested delivery date, but there may be some variation
    3. 3. This request is nice to have and the delivery time frame is flexible
17. Request Description
    Please describe the specific GIS data being requested.
19. Request Objective or Purpose
    Please be as detailed and specific as possible regarding the intended purpose of this request. Also, please indicate specifically how the GIS data requested will be utilized within your organization.
21. Request Parameters
    Provide the specific township/range of your request.
23. Data Delivery Method
    Please indicate the method that is expected to be used to deliver this report to the end user. The default for Campbell County is to send the data to the organization contact email address specified above in a shape file format. However, if a different method of delivery of data format is intended, please specify.
25. Special Considerations or Other Comments
    Please add any additional information that should be considered during the process to address this GIS data request.
27. Disclaimer
    Once this form is received, Campbell County personnel will review the request to determine if it can be fulfilled. Any GIS data that will be provided is not intended for use, copy, distribution or delivery to anyone except for the intended addressee. Any plans to share this GIS data with another party must be approved by Campbell County. All reasonable precautions will be taken to ensure that the GIS information is the latest data available. Due to sudden and constant changes to our system, the data provided is considered out-of-date upon receipt and should only be used for guidance purposes, consulting or permitting Campbell County projects.
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29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit Submit and Print

* indicates a required field