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MPSCS
Bi-Directional Amplifier Data Form
*Completed by
*Date
*Email
User Agency Contact Information
*
Agency/Company Name
*
Contact Name
Address
City
Zip Code
*
Phone Number
*
Email
Maintenance Contact
Same as above
Maintenance Contact Agency/Company Name
Maintenance Contact Name
Maintenance Contact Address
Maintenance Contact City
Maintenance Contact Zip Code
Maintenance Contact Phone Number
Maintenance Contact Email
BDA System Information
*
BDA make and Model
*
BDA System Type
-- Select One --
Channelized (Class A)
Unchannelized (Class B)
*
BDA Service Location Type
-- Select One --
Indoor
Outdoor
Mobile (Channelized Only)
*
BDA Frequency Band
-- Select One --
763-775 MHz/ 793-805 MHz
806-817 MHz / 851-862 MHz
763-775 MHz / 793-805 MHz and 806-817 MHz/ 851-862 MHz
BDA Donor Site (if known)
BDA RF ERP to Donor Site (watts)
BDA Location Information
BDA Location Address
BDA Location City
BDA Location Zip Code
and/or BDA Location Coordinates
Latitude
Longitude
BDA Installation Location Description
BDA Coverage Area Description
Additional Information
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