Site Marketing Program Application Form

Customer D/B/A: Application Date: www.T- MobileTowers.com T-Mobile Site Number / Name: / Customer Site Number / Name: / Date of Existing Lease Agreement: Modification Application Type:

T-Mobile Towers Modification Application

For consideration, in addition to this completed application, T-Mobile REQUIRES: (1) Specification sheets for all antennas existing and proposed (including radiation pattern), mounting bracket(s), coaxial cable, base station equipment, and any other equipment proposed to be placed on the tower. (2) Sketch of site compound showing additional ground space, if needed, in relation to existing ground lease rights. Incomplete or inaccurate application information may cause delays in processing your modification request. Please remit application fee to: T-Mobile USA, PO Box 70870, CM9762, St. Paul, MN 55170 *Please remember to insert the T-Mobile Site ID on the memo portion of the check

You may also submit your application via email to [email protected]

Site Information: Site Address: Latitude:  ' " Longitude:  ' " Customer Information: Legal Entity Name: DBA: Error: Reference source not found

Licensed with the FCC? Yes No - If Yes, FCC License Number: Mailing Address: Carrier Development Manager Name: Mobile: Email: Billing Contact Name: Phone: Fax: Email: Billing Address (for Rent Payments): Carrier RF Contact Name: Phone: Fax: Mobile: Email: Site Acquisition Contact Name: Phone: Fax: Mobile: Email: Proposed Modification Construction Start Date:

Equipment Information: Please describe the proposed alteration(s), including manufacturer’s information for both existing and proposed equipment. Please include MW dishes (current or proposed).

- TOTAL EXISTING LEASED CONFIGURATION - - TOTAL LEASED CONFIGURATION POST MODIFICATION - List everything Applicant currently has lease rights to, List everything Applicant wants to have lease rights to after modification, whether it is installed or not. including equipment that is not being removed. Antennas Antennas

Sector / Quantity Manufacturer and part Centerline Sector / Quantity Manufacturer and part Centerline Azimuth number(s) Azimuth number(s) Alpha / Alpha / ° ° Beta / Beta / ° ° Gamma / Gamma / ° ° Additional Tower Equipment Additional Tower Equipment

Type Quantity Manufacturer and part Centerline Type Quantity Manufacturer and part Centerline number(s) number(s) Amplifier Amplifier

Diplexer Diplexer

MW MW

Other Other

Coax / Transmission Lines Coax / Transmission Lines

Quantity Diameter(s) Manufacturer and part Total length Quantity Diameter(s) Manufacturer and part Total length number(s) number(s)

T-Mobile Towers Modification Application v01.02.09 Equipment Information Continued:

Tx: Tx: Rx: Rx: Max Power: Max Power:

Ground Space Ground Space

Dimensions Equipment Dimensions Equipment

Additional Comments/Requests:

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INFORMATION IN THIS WEB SITE IS PROVIDED "AS IS" WITHOUT ANY EXPRESS OR IMPLIED WARRANTIES, INCLUDING BUT NOT LIMITED TO THE IMPLIED WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, AND NONINFRINGEMENT. T-MOBILE SHALL NOT BE LIABLE TO ANY PARTY FOR ANY DIRECT, INDIRECT, CONSEQUENTIAL OR OTHER DAMAGES FOR USE OF THIS WEB SITE OR OTHER HYPERLINKED WEB SITES.

AT ANY TIME, T-MOBILE MAY WITHOUT NOTICE MAKE CHANGES TO THIS WEBSITE

T-Mobile Towers Modification Application v01.02.09