City of Fairmont

info@fairmontwv.gov

200 Jackson Street, Fairmont, WV, 26554, US

304-366-6211

Print Document

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Create Your Signature

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I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.

Additional Signatures Required

Document Signers

- 1 Signer1
- 2 Shae Strait
- 3 Ken Fletcher
- 4 Brian Starn

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Please provide accurate information below to ensure the delivery of the signed copies of the document.

Listed Signers

	Signer Details	Me?
Signer1
I'm not a signer listed above

Other Signers (The signers below will be invited to sign once the above signers have signed.)

	Shae Strait
	Ken Fletcher
	Brian Starn