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1.General Info: (as it should appear on license)

   Name/DBA:

Fed Tax ID #:

​2.Applicant is a(n): 



3.Mailing address: (to be used on license/application)






​4.Full name of person who will be signing the application


5.Phone number of individual above


6. Type of Radio Service: (ie. Business, Public Safety, etc.)





7. What kind of license is the application for? 

8. If answer to above is modified or reinstated, give previous Call Sign

9. This application will be for:


10. Control Stations with Antenna over 20':
Base Transmitter Location:

Address: (Include City, State, Zip, and County)                                      Structure Type: Code








Height of support structure (meters): 

Height of structure & antenna (meters):

Owner of structure: 

Telephone:                                                      Fax: 

Has the FAA been notified?                                  Registered with the FCC?

Tower #:

Latitude, N: 

Longitude, W: 
(NAD83)
Ground Elevation (meters): 

11. Control Stations with Antenna under 20':
Primary Control Point:

Primary Control Telephone: 

Address: (Include City, State, Zip, and County)








12. Base Frequencies - 
I am requesting this # of frequencies:

          VHF               UHF             (470+, 800, 900MHz freq.)

Frequency type:




Base freq.:                                              # units:

    Output:                                        watts ERP:

14. Number of portables: 


           Vehicles              Hand Helds                Pagers 

Areas of operation: (Miles, Counties, or State)



Required on all Mobile only apps:



15. Emission:  

​      Manufactured by: 

16. Applicant's Business activity - 
We are engaged in the business of:                                                Radios are used for: 







Additional Comments: 










email address: 
Description:
License Application
13. Mobile Frequencies - 
I am requesting this # of frequencies: 

             VHF               UHF               (470+, 800, 900MHz freq.)






Mobile freq.:                                               # units: 

         Output:                                        watts ERP: