Application For Frequency Coordination (Rfc) Form - Scrrba
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1(RFC)
A
F
C
PPLICATION FOR
REQUENCY
OORDINATION
SAVE AS
PRINT
CLEAR
E-MAIL
Mail to: SCRRBA, P.O. Box 5967 Pasadena,Ca 91117-5967
Enclose a copy of FCC license, Site Agreement and a copy of your system block diagram.
Please submit a completed RFC for each transmitter and a copy of the System RF Path block diagram.
Instructions
Select
Select
Select
Application:_______
System
Type:_________________
BAND:_______________
Select
System Call ________
Emission Mode:________________
Bearing _____
Select
Output Frequency ___________
Mhz
Tx Ant Gain ______ dBd
Bearing _____
Mhz
Input Frequency
___________
Rx Ant Gain ______ dBd
Select
Location _________________________________
Power Output ______ W
Select
Building _________________________________
TX Antenna type __________________
Select
Select
ID Type ________________
RX Antenna type __________________
Select
Elev. _____Ft.(MSL) Ant. Height ____Ft.(AGL)
Property Control:___________
______________
___ ' _____"N Long ____
___ ' _____ " W
o
o
Datum ______
Select
Lat ___
Link Destination _______________________________
Lat ___ o ___ ' _____"N Long ____ o ___ ' _____ " W Bearing ____
o
True North
System Access ____________
Select
code _________________________
Select
System Info: Call Sign ________ Type ________________ Name ______________________________________________________________
Coordinee:
Call Sign ________ Name ____________________________________________ E-Mail _________________________________
Physical Address ___________________________________________________ City ____________________ State ___ Zip ______________
Mailing Address ____________________________________________________ City ____________________ State ___ Zip ______________
Home Phone
________________
Fax
________________
Cell Phone
________________
Work Phone
________________
Primary Contact Info: Call Sign ________ Name _________________________________ E-Mail _________________________________
Physical Address ___________________________________________________ City ____________________ State ___ Zip ______________
Mailing Address ____________________________________________________ City ____________________ State ___ Zip ______________
Home Phone
________________
Fax
________________
Cell Phone
________________
Work Phone
________________
Alternate Contact Info: Call Sign ________ Name _______________________________ E-Mail _________________________________
Physical Address ___________________________________________________ City ____________________ State ___ Zip ______________
Mailing Address ____________________________________________________ City ____________________ State ___ Zip ______________
Home Phone
________________
Fax
________________
Cell Phone
________________
Work Phone
________________
NOTES:
Submitted By : _________________________________________________ Call Sign ________ Date ______________
SCRRBA 03/08 v1 FM
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