Please enable JavaScript in your browser to complete this form.Building nameAddressAddress Line 1Address Line 2CityState / Province / RegionStrata plan numberSurvey dateNumber of lifts1234Proposed cabinet locationMeasured mobile signal levelin dBmMIMO antenna required *NoYesMIMO extension cable requiredNoYesProposed location of MIMO antennaLength of extension cable required for MIMO GPO availableYesNoDescribe work required to install GPOPower board requiredYesNoLong power cable requiredYesNoLength of power cable required(in metres)Describe any other requirements to connect mains power to unitClose to building telecommunication cabling or lift line circuitYesNoDescribe work required to connect kit to lift line circuitSite accessible without assistanceYesNoSite accessibility detailsPlease note any keys, FOBs or remotes required to access building and kit location.Details of existing circuit(s)Lift 1 FNNLift 1 jumper pair detailsLift 1 service activeYesNoLift 1 result of test callLift 2 FNNLift 2 jumper pair detailsLift 2 service activeYesNoLift 2 result of test callLift 3 FNNLift 3 jumper pair detailsLift 3 service activeYesNoLift 3 result of test callLift 4 FNNLift 4 jumper pair detailsLift 4 service activeYesNoLift 4 result of test callAdditional notesCommentSubmit
