Bi-Directional Amplifier Data Form

All fields are required, unless labeled as (optional).

Completed by Date Email

Building Owner/Property Manager Contact Information (Owner of BDA)

Agency/Company Name Contact Name Address (optional) City (optional) Zip Code (optional) Phone Number Email Check if Maintenance Contact Information is same as above

Maintenance Contact Information

Maintenance Contact Agency/Company Name (optional) Maintenance Contact Name (optional) Maintenance Contact Address (optional) Maintenance Contact City (optional) Maintenance Contact Zip Code (optional) Maintenance Contact Phone Number (optional) Maintenance Contact Email (optional)

BDA System Information

BDA make and Model BDA System Type BDA Service Location Type BDA Frequency Band BDA Donor Site (if known) (optional) BDA RF ERP to Donor Site (watts) (optional)

BDA Location Information

BDA Location Address (optional) BDA Location City (optional) BDA Location Zip Code (optional)

and/or BDA Location Coordinates

Latitude (optional) Longitude (optional) BDA Installation Location Description (optional) BDA Coverage Area Description (optional) Additional Information (optional)

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Bi-Directional Amplifier Data Form

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