COLLOCATION Application (Canada)

(Tab thru the Fields to Enter Info; if at Any Time You Need to UNLOCK the Form to Manually Add Something, you Must Add the “Lock” Icon to your Toolbar to Unprotect Form, NO Password Needed)

468 Saint-Jean Street, Suite 400

Montreal, Quebec H2Y 2S1
Attention: Serge Charron / Main Tel: 514-656-5233 Ext. 1310
Fax: 514- 303-0697
E-mail:
Site Information
Date: // / SBA Site ID: / SBA Site Name:
Latitude: °' " / Longitude: -°' " / Source of Coordinates:
AGL: / City: / Province:
Tenant Information
Site ID: / Site Name:
Company Name: / Company Representing:
(if consultant)
Contact Name: / Contact Address:
Contact Phone: () -
Contact Fax: () - / Contact e-mail: @.
Leasing Information
Contact Name:
(if different) / Phone: () -
Name of Company to Appear on Lease: / Province Incorporated: / Federal Tax ID #: -
Provincial Tax ID #: -
Signatory Name: / Signatory Title:
Corporate Address: / Notice Address:
With Copies to:
Name / Phone & Address to Send Leases For Execution:
(if different) / # of Original Leases Required(for Tenant only): / Special Instructions:
Construction Information
Contact Name: / Phone: () -
Fax: () - / E-mail: @.
Mobile: () - / Projected Installation Date: //
Tenant 24 Hour Emergency Contact (NOC)
Name: / Phone: () -
Equipment Specifications(NOTE: PLEASE USE METRIC STANDARD MEASUREMENTS, NOT AMERICAN)
ANTENNA/MOUNTING/COAX: / GROUND SPACE REQUIREMENTS:
Quantity: / Tenant Provided Shelter/Pad or Owner Provided Bldg Space
Type(panel, omni, receive, transmit, etc.): / Exact Dimensions: x
Mfg: / Type: Shelter Pad
Model: / (SBA’s) Shelter Space Dimensions Needed:
m Xm Xm
Dimensions: Length x Width x Depth / GENERATOR:
Weight: kg / Generator Pad Size: x
Height at base of the antenna: m / Mfg / Model: /
Height at centerline of the antenna: m / Type: Propane Diesel
Height at tip of the antenna: m / Power: kw / Capacity: L
Down Tilt: / GROUND EQUIPMENT SPECIFICATIONS:
Orientation: / Transmitter:
Mount Make/Model: / / Quantity:
Mount Weight: kg / Manufacturer:
# of Lines: / Model:
Coax Type: / Power Output (Watts):
Coax Size: / Transmitter Cabinet:
DISH: / Quantity:
Quantity: / Manufacturer:
Mfg / Model: / / Model:
Dimensions / Weight: /kg / Dimensions: xx
Mounting Height / Type: m / / Weight: kg
Orientation: / FREQUENCIES(Exact):
# of Lines: / Exact TX:
Coax Type: / Exact RX:
Coax Size: / POWER:
TTA / TMA / BTS / ODU / RRH / RET: / ERP:
Type (TTA, MHA, etc.): / Transmitter Operating Power:
Quantity: / IS SBA AN APPROVED CONTRACTOR: Yes No
Mfg / Model: / / SPECIAL REQUIREMENTS:(please list anything else that may be placed on tower (GPS)or not covered in app.)
Dimensions / Weight: /
Mount Location: m
# of Lines:
Coax Size / Type:

Main Template Revised 2/13/12