Form 601 - Supplement To Fcc - Frequency Coordination Request Form printable pdf download

RS/MRFAC

PH: 800-262-9206

FREQUENCY COORDINATION REQUEST FORM – SUPPLEMENT TO FCC Form 601

Applicants must also supply a signed FCC Form 601 Main Form Page 4 with this supplemental form If you need

assistance with this form, please contact the coordination office for details.

APPLICANT/LICENSEE

CONTACT REPRESENTATIVE

Licensee Name:___________________________________________ Name:_______________________________________

Address:___________________________________________________ Company:___________________________________

City/St/Zip:_______________________________________________ Address:____________________________________

Ph# / Fax#:_______________________________________________ City/St/Zip:_________________________________

Business Activity:_________________________________________ Ph# / Fax#:_________________________________

Email:______________________________________________________ Email:_______________________________________

FCC Registration Number (FRN):

______________________________________



Type of Request



New

Modification / Renewal / Reinstatement Call Sign: _________________________

Frequency Band Requested:



25-50MHz

72/75MHz

150/174MHz

154/173MHz Telemetry

450-470MHz

800/900MHz



This request is for:

Single Frequency

Frequency Pair

Multiple Frequencies (Total # _________)

Transmitter Information

Base Station / Repeater

Output Power___________________ / ERP____________________

# Pagers__________

Mobile/Hand-Held Information

***Is this request for Mobile Only or Hand-Held Only Use?

Yes

No

***If YES, please provide Model Number of Units__________________________________________________

# Vehicles______________

Output Power___________________ / ERP____________________

# Hand-Helds_________

Emission Desigantors MUST be Narrow-Band Compliant with the exception of specific “Paging” frequencies and

channels above 800MHz.



Analog

Voice

Data

Digital (Provide Brand Name and Band-Width):________________________

COMMENTS __________________________________________________________________________________

_______________________________________________________________________

Frequency Coordination Fees are due when application is submitted for coordination. We accept check, wire transfer

and credit cards – payable to the chosen coordinator: RS/MRFAC

RadioSoft, Inc., 194 Professional Park Drive, Clarkesville, GA 30523-5536

Form 601 - Supplement To Fcc - Frequency Coordination Request Form

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