| 1. License Information *All Blocks in Section One are Required!* | |
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Call Sign: |
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Expiration Date: |
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Licensee Name: |
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Contact Person: |
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Street Address: |
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City: |
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State: |
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Zip Code: |
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email Address: |
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Phone: |
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Fax: |
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Licensee's 9 Digit Federal Tax
ID Number |
(The same number needed on IRS form W-9.) |
| Referred to Atlas
by:
Internet Search
Advertisement
Mail
Other Please describe: Dealer (Please enter Dealer name:) |
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| By typing your 'signature' below, and clicking the "Submit" button at the end of this form, the licensee named above gives Atlas License Company & Data Services (ALCDS) authority to submit this license renewal on its behalf. The applicant also grants permission for ALCDS to obtain a password from the FCC for purposes of electronic filing processes pertaining to this license renewal. The applicant further confirms the information given to ALCDS has been provided accurately and honestly. Information submitted to the FCC is reviewed for inaccuracies and inconsistencies, possibly leading to fines or penalties for which the licensee is solely responsible. | |
| Licensee's
Authorized 'Signature':
(Type your full 'signature' here.) (or Licensee's Authorized Representative) |
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| Title: | Date: |
| 2. License Guard | |
| Atlas offers a subscription to License Guard to guarantee you of certified notification several months prior to license expiration. Click Here for a full description of our License Guard services. If you'd like to add License Guard protection to this renewal, check here . | |
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| 3. Fee Calculation | |
| PLEASE review the form before clicking the Submit button below. ALL blocks in section 1 must be completed in order for us to accurately calculate the fees for your specific license. When all the information is complete, click the Submit button. After clicking the Submit button, our server will display a "Form Confirmation". Please print the Form Confirmation for your records. Clicking the Reset button will clear the entire form and allow you to re-enter all the information. Within one full business day or receiving your online renewal application. we'll respond to the email address indicated on this form with a confirmation including total fees and available payment options. Payment options will include: check (mailed) or American Express, MasterCard, or Visa (mailed or faxed). Atlas must receive your payment before we can file your renewal. There is no grace period on license expirations so renewal filings are more critical than ever! Once you've received your confirmation, please don't delay! | |
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Special Requests
Please use the space below to enter any special requests or comments regarding this license renewal.
Thank You for Choosing Atlas License Company & Data Services!