Applicant Registration Form
Grantee Code: Date Open: (MM/DD/YYYY) IC Company Number: (6 Alphanumeric)
* Required Fields
*Complete, legal business name:
Address
*Line1
Line2		P.O. Box
*City		State
Country		Zip Code
*FRN	(FCC only - enter TBD if FRN is not known/ required) Click Here to access the FCC CORES system to request an FRN
Contact Person
*First Name		M.I
*Last Name
Title
Mail Stop
*Telephone	Ext Fax
*Email
*Password	Maximum 20 characters
*Confirm Password