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GIS Data Request Form Revised

  1. If not a company please type "self" into field.

  2. Refer to 'GIS Fee Schedule' for product list and related fees.

  3. Please describe in detail the specific use(s) of the requested GIS Products

  4. Available Data Formats:

    Note: Some data items exist solely in a fixed format.

  5. Images (Raster Data):

    Select One

  6. Digital Vector Data:

    Select One

  7. User Type:*

  8. Media Type:*

  9. Additional information!

    Additional documentation will be needed following the submission of this data request. Once we receive the submitted form we will send a signature page via email for you to fill out, scan, and return to us for our records. GIS Data is copyrighted for 2017/2018 by Luzerne County, Commonwealth of Pennsylvania, all rights reserved. No part of this GIS Data may be copied, reproduced or transmitted in any form or by any means whatsoever whether graphic, electronic or mechanical, including photocopying, posting on the internet, recording, or through the use of an informational storage and retrieval system, without prior written permission of Luzerne County.

  10. Leave This Blank:

  11. This field is not part of the form submission.