Tower Co-Location Application

Please fill out and submit the form below or if you'd prefer to fax or mail it to us, you may also download the application as an Adobe PDF file.

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SITE INFORMATION

PDG Site Name

CUSTOMER INFORMATION

Customer Site Name:

Licensed entity name (full legal name):

Address:

City:

State:

Zip Code:

State of Incorporation:

Contact Person:

E-mail Address:

Phone:

Billing Address:

Billing City:

Billing State:

Billing Zip Code:

Billing Phone:

TIN#:

Signatory Title:

Signatory:

ANTENNA SPACE & EQUIPMENT

Antenna quantity & type:

Mounting height (s):

Number of lines per antenna:

Line diameter:

GROUND SPACE

Square footage required within compound:

Equipment shelter/cabinet/BTS requirements:

LEASE TERMS

Proposed monthly lease amount:

Proposed annual escalator:

Proposed lease commencement date: