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Business Radio Licensing
Worksheet
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Date: Request Special Temporary Authority (STA)
Emergency Reason for STA
Communications Company: Salesperson:

Address: City: State: Zip:

Phone: Fax:
Invoice:             Send forms to :
Legal name of licensee:
Contact person: Title:
Phone: Fax:
Mailing Address: Physical:
City: State: Zip: County:
1. Type of entity
2. Type of request: New license
      If modification list call sign:
3. Frequency requesting:
4. Frequency band requested: 12.5 offsets
Indicate minimum and maximum splits of VHF repeater:
5. Which type of system are you proposing:
6. Type of system sold:
  Add on to existing community repeater (FB4)    Commercial/private carrier (FB6)
  Customer owned single user repeater (FB2/mo)    Paging system (FB)    Fixed Operational system (FXO)
7. Wattage of the equipment sold: Base
8. What is the bandwidth being requested:
9. Will the system be interconnected with public switched telephone network?
10. Type of emissions:
11. Amount of radios used/purchased:
 12. Location of transmitter(s):
      Major cross streets: City: County: State:
 13. Antenna mounted on:
      Antenna height above ground ft.      Height of structure (not including antenna) ft.
 14. Latitude: N             Latitude: W (if not known leave blank)
 15. E-Mail Address:
 16. Additional_comments:
     

Download Form 601 in PDF format

Business Radio Licensing • 30251 Golden Lantern, Suite E #501 • Laguna Niguel, CA 92677-5993 • Toll Free: 800-783-9006