Licensee

Licensee (as it will appear on license)

FRN

CORES Password

Attention:

If your company does not have an FRN (FCC Registration Number), provide EIN (Employer Identification Number) on the notes section below and we can obtain an FRN and CORES password for you.

Address

P.O. Box

City

State

Zip Code

Phone No

Fax No

Email

CONTACT

for issues concerning application

First Name

MI

Contact Last Name

Suffix

Contact's Company

PO Box

Address

CIty

State

Zip Code

Phone No

Fax No

Email

CONTROL POINT

Point of contact for system operation *optional*

Address

CIty

State

County

Phone No

NAME OF PERSON SIGNING FORMS

Please include full name, including prefix and middle initial

First Name

Middle Inital

Last Name

Suffix

Title

Will system be interconnected with the public telephone system?

Yes
No

Is licensee U.S. owned and organized as per FCC Alien Qualifications?

Yes
No

Does the license applicant meet the FCC's Basic Qualifications?

Yes
No

Site A

Site Name

Call Sign (if applicable)

Latitude

DD-MM-SS.S

Longitude

DD-MM-SS.S

Latitude / Longitude Datum

Elevation AMSL

Units

FCC Tower Registration #

if applicable

Frequency Band

or Channels Desired

Manufacturer

Model

Antenna Height - AGL

Units

Radio Manufacturer

Radio Model

TX Power

Bandwidth

Line Loss (dB)

Number of Desired Channels

Antenna Structure

Structure Height w/o Appurtenances

Units

Structure Height w/ Appurtenances

Units

Site Address or Description

Nearest City

Site B

Site Name

Call Sign (if applicable)

Latitude

DD-MM-SS.S

Longitude

DD-MM-SS.S

Latitude / Longitude Datum

Elevation AMSL

Units

FCC Tower Registration #

if applicable

Frequency Band

or Channels Desired

Manufacturer

Model

Antenna Height - AGL

Units

Radio Manufacturer

Radio Model

TX Power

Bandwidth

Line Loss (dB)

Number of Desired Channels

Antenna Structure

Structure Height w/o Appurtenances

Units

Structure Height w/ Appurtenances

Units

Site Address or Description

Nearest City

NOTES

Email

This field is for validation purposes and should be left unchanged.