Shuttlewagon Owner's Mailling Address
|
| Licensee (Company) Name: |
|
| Type of Business: |
|
| Authorized Licensee Contact Person: |
|
| Address: |
|
| City: |
|
| State: |
|
| Zip Code: |
|
| Phone Number: |
|
| Fax Number: |
|
| Email Address: |
|
| Primary Business Activity (i.e. flour mill, power plant, railroad, etc.): |
|
Federal Information
|
|
| Federal Tax ID Number (TIN/EIN): |
|
| FCC Registration Number (If available): |
|
| ULS Password (If available): |
|
Exact physical address where the Shuttlewagon will be located and used
|
| Address: |
|
| City: |
|
| State: |
|
| Zip Code: |
|
| County: |
|
| Coordinates: |
|
| Radius of operation: | Within 5 miles of the address provided Outside 5 miles of the address provided |
| If outside 5 mile radius, please describe intended area(s) of operation: |
|
Licensee Information - Foreign Ownership/Qualifications
|
| Is your company Foreign Owned/Controlled? | Yes
No
|
| If yes, please explain nature and extent of foreign controll: |
|
| Have you had an FCC license/permit revoked? | Yes
No |
| If yes, please explain: |
|
| Have you been convicted of a felony or other crime involving monopolization of radio communication? | Yes
No |
| If yes, explain: |
|