| Applicant
Information Worksheet : GPS Business Entity |
| Date: |
Atlas
Processor: |
| Legal
Name of Applicant: |
|
| Applicant
9-Digit Federal Tax ID Number (SSN or EIN) |
|
| Contact
Person: |
|
| Telephone
Number: |
|
| Fax
Number: |
|
| Mailing
Street Address (Physical): |
|
| Mailing
Suite, PO Box: |
|
| Mailing
City, State, Zip: |
|
| Mailing
County (Not CountRy): |
|
| Applicant's
email Address: |
|
| Dealer
(Referred by): |
|
| Expected
# of RTK Units within 10 Years: |
|
| In
What State(s) will Operations Occur? |
|
| Will
your radios operate within 90 miles of the Canadian border? (Requires
Canadian approval prior to FCC approval.
Up to 5 watts power permitted until FCC grants actual license.
Allow several months for Canadian approval.) |
[
] Yes [ ]
No |
| Transmitting
Power: |
Watts |
| Frequency
Band: |
[
] UHF [ ] VHF |
| PLEASE
fill in the manufacturer of the RTK radio transmitter attached to your GPS
equipment:
|
| Dealer
/ Referred by: |
| Dealer
Contact Person: |
