FCC Frequency Coordination and License Application Form

Applicant Name

Entity Type Entity Type Private Government

Address

City

County

State

Zip Code

Phone Number

Contact Person

9-digit Taxpayer Identification Number (FCC required)

Applicant Email Address

Address of Radio (repeater/base) System (write same if same as above - no P.O. Boxes)

City

County

State

Zip Code

Phone Number

Coordinates

Antenna length

Height of building or tower

Elevation (feet)

Number of units (mobiles and portables)

Area of operation (miles radius of)

Special Instructions

Frequency_or_frequencies_(VHF/UHF)

Dealer Name

Contact person

Address

City

State

Zip Code

Dealer phone number

Dealer email

First & Last name of party authorized to sign (Signatory)

Signatory suffix

Signatory title

Date

13 + 9 =

Please Read Before Submitting Your Application

Upon grant of this license application, the Licensee may be subject to certain construction or coverage requirements. Failure to meet the construction or coverage requirements will result in termination of the license. Consult appropriate FCC regulations to determine the construction or coverage requirements that apply to the type of license requested in this application.