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Orange County NC <br /> 51 <br /> Radio Communication Tower and System Infrastructure Upgrade <br /> RF Coverage and Sites/Towers <br /> Bank References: Please complete attached form. Bank reference form must be signed by an authorized account signer. <br /> No.Employees: Est.Annual Sales$: Sales Territory: <br /> Has the firm or any of its Principals ever been bankrupt? ❑ Yes ❑ No <br /> If yes,explain: <br /> Company Contact for Account information: <br /> Name Title <br /> Phone E-mail address <br /> Crown Castle Account Executive you are working with: <br /> Will you be requiring Site Acquisition or Construction Services? ❑ Yes ❑ No <br /> If yes,and Information is different than Page 1 of the Credit Application,please complete the additional information below. <br /> Business Entity Name: <br /> Address: <br /> Street City State ZIP Code <br /> Federal Tax I.D.Number: <br /> Contact Name: <br /> Contact Phone Number: <br /> Contact Fax Number: <br /> Invoices•Email Address: <br /> Invoices•Fax Address: <br /> 'Please note that if no Email or Fax designation is provided;an invoice will be sent via regular mail <br /> August 30, 2013 Page 50 of 51 -" <br />