Please Be Sure That ALL of the Requested Information Below Is Completed

SITE APPLICATION

Please be sure that ALL of the requested information below is provided. ANew Install Application Fee of $1,500.00 or $1,000 Additional Equipment Application Feeis required to accompany this form for consideration. Please do not hesitate to call us if you have any questions regarding this application.
WichitaTowers Site ID & Name: / Applicant Site ID Name:
Desired In Service Date: / Site Status: Built Not Built (Click to Check One)
Purpose of System (Click & Select): CellularPagingInternet2-WayEmergencyGovernmentOther ______/ Structure Type (Click & Select): MonopoleSelf SupportGuyedLatticeRoof TopWater TowerOther ______

SITE INFORMATION

Please refer to or call 316-219-8557
Street Address:
City: / State: / ZIP:
Latitudes (NAD 83): / -- . W / Longitudes (NAD 83): -- . N

POINT OF CONTACT INFORMATION

This information may include contractor or site acquisition consulting information. Please include information for the initial point of contact – this person will be contacted for any issues prior to an executed lease.
Company Name:
Point of Contact:
Street Address:
City: / State: / ZIP: / -
Phone Number: / . . x / Fax Number: / . . x
E-mail Address:

APPLICANT INFORMATION

This information should not include contractor or site acquisition consulting information. Please include only carrier specific information as it pertains to the leasing process.
Company Name:
Point of Contact:
Federal Tax No.:
Street Address:
City: / State: / ZIP: / -
Phone Number: / . . x / Fax Number: / . .
E-mail Address:
Contract to Be Executed By:
Accounts Payable Contact (Sublease Level):
Are You a Corporation or Partnership?
State in Which Your Business Entity was Formed:
Company Name & Address to Appear on Legal Documents for Notice provision: / Name:
Address:

RF ENGINEERING INFORMATION

(All information must be completed, and should include contacts for construction and post-construction phases.)
RF Contact:
Phone Number: / . . x / E-mail Address:
Construction Contact:
Phone Number: / . . x / E-mail Address:
Network Ops. Contact:
Phone Number: / . . x / E-mail Address:

TECHNICAL PARAMETERS

***Please attach antenna specification sheets*** Please place additional equipment information on the next page.
ALPHA / BETA / GAMMA
Antenna Quantity
Azimuth Orientation (Deg)
Antenna Manufacturer & Model #
Antenna Dimensions (l x w x d / wt)
Antenna Mounting Type
Downtilt Mechanical Elec
TX/RX or Duplexed?
Proposed AntennaCenter Line
Trans Line Type/Size
Total Number of Lines per Sector
Total # TMAs/MHAs per Sector
Power Output
Frequency (MHz and Band Type)

BASE STATION EQUIPMENT

Equipment Type:
Manufacturer: / Model Type:
FCC Type Acceptance Number:
Power Output (Watts):
Is a waveguide truss/cover plate needed from the tower to your equipment space? Yes No (Click to Check)

POWER REQUIREMENTS

Required Voltage & Total Amperage:
Are you providing your own generator back up power? Yes No (Click to Check)
Space required for generator: / Is an additional fuel tank needed?

LAND REQUIREMENTS

How large a parcel or land is required? / Length (ft): / Width (ft):
Will an external shelter be required? Yes No (Click to Check)
/ Page 1 of2 / Phone: 316.219.8557
/ wichita towers site application.doc / Fax: 316.219.8600