Communication Antenna Attachment Billing Detail

FORM 15

Communication Antenna Attachment Billing Detail

Licensee: ______

Communication Antenna Attachment Application Number: ______

Communication Antenna Attachment Agreement ID# (Verizon Use Only) ______

Instructions: For each pole, fill out one Form 15.

Column A: Number each antenna attachment component

Column B: List and Describe each component

Column C: Record the height of each component in feet and inches

Columns D, E and F are for Verizon Use Only

Each component listed below must be already approved in accordance with the Communication Antenna Schematic submitted to Verizon. During a post-construction inspection, if Verizon finds that you have attached equipment components that were not submitted as part of your schematic and approved by Verizon, Verizon may revoke Licensee’s future to perform Self Pre-survey of Communication Antenna Attachments.

For pole number ______, the following rental fees will apply to the Communication Antenna Attachment components:

A B C D E F

ITEM / ITEM DESCRIPTION / Height (Ft & Inches) / PRS Billable Feet
(VZ use only) / Rate Per Foot (VZ Use only / Total for each item
(VZ Use only)
1
2
3
4
TOTAL

Form 15 Communication Antenna Attachment Billing Detail

Revised 3-16-06