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Harmoni Towers10802 Executive Center Drive Little Rock, AR 72211

E-mail: towers@uniti.comOffice: 501.850.0820

Application Submission Date:

Proposed Install Date:

Proposed On Air Date:

UNITI SITE INFORMATION:

Uniti Site Name: Street Address:

Uniti Site Number: City:

Uniti Site Description: State:

Customer Site Name: Zip:

Latitude: County:

Longitude:

APPLICANT INFORMATION:

Applicant Name: Primary Contact Name:

Applicant Title: Company Name:

Applicant Phone: Primary Contact Phone:

Applicant Email: Primary Contact Email:

Legal EntityContract: Primary Contact Address:

Applicant Address (city, state, zip):

Notice Address:

Billing Address:

SITE LICENSE APPLICATION

CUSTOMER / CARRIER INFORMATION:

Leasing Contact Name/Number/E-mail:

RF Contact Name/Number/E-mail:

Legal Review Contact Name/Number:

Zoning Contact Name/Number:

Construction Contact Name/Number:

Site Tech Contact Name/Number:

Emergency Contact Name/Number:

Harmoni Towers Site License Application

DocuSign Routing:

DocuSign Routing:

Harmoni Towers Site License Application

Sector Arrangement Antenna Position

North

Sector X

1 2 3 4A B C

North most sector

**PLEASE ATTACH SPEC SHEETS FOR ALL ANTENNAS & EQUIPMENT.

ANTENNA / MW INFORMATION (Make & Model): RADIOS & AMPS (Make, Model, ie RRU, TMA) RAD CENTER (ft) AZIMUTH (deg) TRANSMISSION LINE

Antenna Position:

Technology & Frequency

Make & Model Existing

Make & Model New

Make & Model Existing

Make & Model New Existing New Existing New

Cable Length

(ft)

CableDiameter

(in)

Make & Model Number

Sect

or 1

1

A

2

B

3

C

4

Sect

or 2

1

A

2

B

3

C

4

Sect

or 3

1

A

2

B

3

C

4

ANTENNA / MW INFORMATION (Make & Model): RADIOS & AMPS (Make, Model, ie RRU, TMA) RAD CENTER (ft) AZIMUTH (deg) TRANSMISSION LINE

Antenna Position:

Technology & Frequency

Make & Model Existing

Make & Model New

Make & Model Existing

Make & Model New Existing New Existing New

Cable Length

(ft)

CableDiameter

(in)

Make & Model Number

Sect

or 4

1

A

2

B

3

C

4

Sect

or 5

1

A

2

B

3

C

4

Sect

or 6

1

A

2

B

3

C

4

Harmoni Towers Site License Application

CUSTOMER / CARRIER INFORMATION:

Equipment Enclosure Type: BTS Cabinets/Number of BTS Cabinets:

Outdoor Shelter:

Other:

Leased Area Dimensions (WxD) (ft)

Cabinet/BTS/Shelter Dimensions (HxWxD) (ft):

Concrete Pad Dimensions (WxD) (ft):

Cabinet/Shelter Manufacturer/Model:

POWER REQUIREMENTS:

AC Power:Required

Voltage and TotalAmperage:

GENERATOR INFORMATION:

Generator Ground Space Requirement (HxWxD) (ft) Fuel Type:

Propane

Diesel

Natural Gas

Fuel Tank Size (Gallons): Fuel Tank Location:

Attached

Separate

None

Capacity (KW):

ADDITIONAL INFORMATION / COMMENTS:

• Ground lessor consent may be required as a condition to the executionof your lease.

• Modifications to the tower site may be subject to local zoning approval.

• **Attach manufacturer’s equipment specifications for antennas, radios,amps, mounts, cabinets, shelters, etc.

• Contact towers@uniti.com with questions.

Harmoni Towers Site License Application

Harmoni TowersSITE LICENSE APPLICATION