Optasite - Cell Tower Colocation and Leasing

Please fill out sections 1-5 below, and press the Submit button at the bottom of the page to submit your application online. You may also submit this form by mailing or faxing a completed copy of this application to Director – LAPM, Optasite Inc, One Research Drive, Suite 200C, Westborough, MA, 01581 (kgallagher@optasite.com, (F) 508-471-1399).

Once your application is received, an Optasite Leasing Representative will contact you to discuss the leasing process and answer any questions you may have. Should you have questions prior to submittal of this form, or anytime during the leasing process, please call 508-799-2460 (Option 2) to contact our leasing group.

Site Information					Date:	09/08/08
Optasite Site Name/Number *
Customer Site Name/Number
Street Address, City, State, Zip
Lattitude/Longitude
Customer Contact Information	Name	Title	Telephone	Email	Address
Signatory *
Real Estate Manager
RF Engineer
Construction Manager
Site Acquisition Manager
Emergency Contact
Accounts Payable
Other

Licensed Entity Name*				State of Incorporation
Notification Address*
Billing Address
Address to Send Due Diligence Package
Antenna Space and Equipment	Sector 1	Sector 2	Sector 3	Other	Other	Other
Quantity
Receive or Transmit
Manufacturer
Types of Antennas
Model #
Antenna Weight (per antenna)
Antenna Dimensions (HxWxD)
Mount Height
RAD Cener AGL
Direction of Radiation (Azimuth)
TX Frequency
RX Frequency
Number of Lines Per Antenna
Line Diameter
Building/Shelter Space and Equipment
Type of Enclosure			Leased Ground Space Dimensions (W x L x H)
Generator (Yes/No)			Generator Leased Ground Space Dimensions (W'x L'x H')
Generator Fuel Type			Generator Fuel Tank Ground Space Dimensions (W'x L'x H')
Telco/Interconnect Requirements			Power Provided By:
Type of Service			Average Monthly Power Consumption (kw)
Electric Service Required (Amps/Volts)
Electric Service Required (Amps/Volts)
Other Comments