Pike County
Data Request Form and Agreement
Requ
ested By: _________________________________________________________
Company Name: _________________________________________________________
Email Address: _________________________________________________________
Date Requested: ________________
Phone Number: ___________________________
Data Requested:
For Commercial Use: YES NO
Data Formats
available: .csv .xls
Method of Delivery: Email CD-ROM
Paper
Pike County and its municipalities shall not be held liable for any errors in the data provided as a result of this
request. This includes errors of omission, errors concerning the content of the data and relative positional
accuracy of the data. The data cannot be construed to be a legal document. Primary sources from which the
data has been compiled must be consulted for verification of the information contained in this data.
Requestor agrees to make payment as specified to Pike County. No data will be released until payment is made
in full, and if payment is made by check, we will hold your request until your check has cleared the bank.
The person signing warrants that he or she has the authority to bind the employer to abide by the terms of this
agreement.
____
______________________ _______________________________ _____________
Requestor Signature Job Title Date
Contact Information:
John Ivey
Pike County IT
E-mail: jivey@co.pike.ms.us
Phone: (601) 783-2001
ATTENTION: NO DATA WILL BE RELEASED UNTIL PAYMENT HAS BEEN MADE, AND IF APPLICABLE, CLEARED FOR
PAYMENT. WE ONLY ACCEPT PAYMENT BY CHECK, MONEY ORDER, OR CASH NO CREDIT CARDS
GIS Data Contact Information:
Laurie Allen
Pike County Assessor
E-mail: lauriea@co.pike.ms.us
Phone: (601) 783-4130
