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Name
Address
City
State / zip
Phone
Email
Site Name
Site Address
City	State    Zip
County	Country  Foreign Zip Code
Foundation Type	PIER MATT   Yes / No
Ice	THICKNESS  ICE   Yes / No
Wind Speed	MPH     3 sec. gust.  Yes / No
Tower Height	Type of antenna Mounts
Revision	Revision F            Yes / No        Revision G              Yes / No
Special  -
Request
Lighting Kit	Yes / No  Lighting required if tower extends beyond 199'
	Antenna Model @ Size
	Quantity   Height on Tower
	Quantity   Height
	Quantity   Height
	Quantity   Height
	Quantity   Height
	Quantity   Height
	Quantity   Height
	(1) Bottom Ports: 3' @ 0°     EXIT PORT LAYOUTS	Yes / No
	(2)Bottom Ports: 3' @ 180°	Yes / No
	(3) Bottom Ports: (2ea) 3' 0°/180°  and (1) @ 8' 90°	Yes / No
	(4) Bottom Ports: (2ea) 3' 0°/180°  and (2) @ 8'	Yes / No
	(5) Bottom Ports: (2ea) 3' 0°/180°, (2) @ 9" 90°/270° and (1) @ 6" 0°	Yes / No
	(6) Bottom Ports:  (2ea) 3' 0°/180°, (2) @ 9" 90°/270° and (1) @ 6" 0°/180°	Yes / No
	EMAIL ANTENNA CUT SHEETS AND QUANTITY OF LINES AND SIZE PER ANTENNA.  Call if you need assistance we have someone to answer your questions 7 days a week,    360-474-8991

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