Worksheet Submitted: ${date}
Requesting Application: ${request_by}
Invoice: ${invoice_to}
Send forms: ${send_forms_to}
Comm Co:
${communication_company}
${address}, ${city}, ${state}, ${zip}
Sales:
${sales_person}
Tele: ${phone}
Fax: ${fax}
Email: ${comm_email}
Licensee:
${legal_licensee_name}
${contact_person_title}
${contact_person_mail_address}
${contact_person_physical_address}
${contact_person_city}, ${contact_person_state}, ${contact_person_zip}
Email: ${licensee_email}
Contact:
${contact_person_name}
Tele: ${contact_person_phone}
Fax: ${contact_person_fax}
Type of Entity: ${entity_type}
Type of request: ${request_type}
Call sign: ${modification_call_sign}
Expire: ${modification_expiration}
Monitor: ${needs_monitor}
Specific Frequency requesting: ${frequency_request}
Frequency band requested: ${frequency_band_request}
Indicate minimum & maximun splits if requesting a VHF repeater: ${min_max_vhf_repeater_splits}
Which type of system are you proposing: ${proposing_system_type}
{%if typeof sold_system_type != 'undefined' %}
Type of system sold: ${sold_system_type}
{%/if%}
Wattage of the equipment sold
Mobile: ${sold_equipment_wattage_mobile}
Portables: ${sold_equipment_wattage_portable}
Base: ${sold_equipment_wattage_base}
Repeaters: ${sold_equipment_wattage_repeater}
What is the bandwidth being requested: ${bandwidth_requested}
Type of emissions: ${emission_type}
Equipment Manufacturer: ${equipment_manufacturer}
Will the system be interconnected with public switched telephone network?: ${interconnected_with_public_switched_telephone_network}
Amount of radios used/purchased M:${radios_used}
P: ${pagers_used}
{%if transmitter_location_1 != '' %}
Location of transmitter: ${transmitter_location_1} ${transmitter_location_city_1} ${transmitter_location_state_1}
Major cross streets: ${major_cross_streets_1}
County: ${transmitter_location_county_1}
{%if typeof antenna_mounted_on_1 !== 'undefined' %}
Antenna Mount:${antenna_mounted_on_1} ${antenna_mounted_on_other_1}
{%/if%}
{%if antenna_height_1 != '' %}
Antenna height above ground:${antenna_height_1}
{%/if%}
{%if structure_height_1 != '' %}
Height of Structure: ${structure_height_1}
{%/if%}
{%if latitude_1 != '' %}
Latitude: ${latitude_1}
{%/if%}
{%if longitude_1 != '' %}
Longitude: ${longitude_1}
{%/if%}
{%/if%}
{%if typeof transmitter_location_2 !== 'undefined' %}
Location of transmitter: ${transmitter_location_2} ${transmitter_location_city_2} ${transmitter_location_state_2}
Major cross streets: ${major_cross_streets_2}
County: ${transmitter_location_county_2}
Antenna Mount:${antenna_mounted_on_2} ${antenna_mounted_on_other_2}
Antenna height above ground:${antenna_height_2}
Height of Structure: ${structure_height_2}
Latitude: ${latitude_2}
Longitude: ${longitude_2}
{%/if%}
{%if typeof transmitter_location_3 !== 'undefined' %}
Location of transmitter: ${transmitter_location_3} ${transmitter_location_city_3} ${transmitter_location_state_3}
Major cross streets: ${major_cross_streets_3}
County: ${transmitter_location_county_3}
Antenna Mount:${antenna_mounted_on_3} ${antenna_mounted_on_other_3}
Antenna height above ground:${antenna_height_3}
Height of Structure: ${structure_height_3}
Latitude: ${latitude_3}
Longitude: ${longitude_3}
{%/if%}
{%if typeof transmitter_location_4 !== 'undefined' %}
Location of transmitter: ${transmitter_location_4} ${transmitter_location_city_4} ${transmitter_location_state_4}
Major cross streets: ${major_cross_streets_4}
County: ${transmitter_location_county_4}
Antenna Mount:${antenna_mounted_on_4} ${antenna_mounted_on_other_4}
Antenna height above ground:${antenna_height_4}
Height of Structure: ${structure_height_4}
Latitude: ${latitude_4}
Longitude: ${longitude_4}
{%/if%}
{%if typeof transmitter_location_5 !== 'undefined' %}
Location of transmitter: ${transmitter_location_5} ${transmitter_location_city_5} ${transmitter_location_state_5}
Major cross streets: ${major_cross_streets_5}
County: ${transmitter_location_county_5}
Antenna Mount:${antenna_mounted_on_5} ${antenna_mounted_on_other_5}
Antenna height above ground:${antenna_height_5}
Height of Structure: ${structure_height_5}
Latitude: ${latitude_5}
Longitude: ${longitude_5}
{%/if%}
{%if typeof transmitter_location_6 !== 'undefined' %}
Location of transmitter: ${transmitter_location_6} ${transmitter_location_city_6} ${transmitter_location_state_6}
Major cross streets: ${major_cross_streets_6}
County: ${transmitter_location_county_6}
Antenna Mount:${antenna_mounted_on_6} ${antenna_mounted_on_other_6}
Antenna height above ground:${antenna_height_6}
Height of Structure: ${structure_height_6}
Latitude: ${latitude_6}
{%if longitude_6 != '' %}
Longitude: ${longitude_6}
{%/if%}
{%/if%}
{%if additional_comments != '' %}
Additional Comments: ${additional_comments}
{%/if%}