Gpsc Form 500-1 - Application For Permit To Use Automatic Dialing And Announcing Devices (Adad) - Georgia Public Service Commission Page 2

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Georgia Public Service Commission
244 W
S
, SW
ASHINGTON
TREET
A
G
30334-5701
TLANTA
EORGIA
_________________________
Date of Application
APPLICATION FOR PERMIT TO USE
AUTOMATIC DIALING AND ANNOUNCING DEVICES (ADAD)
SECTION I. APPLICANT'S ADDRESS
Name of Applicant:
________________________________________________________________________________
Address:
Street
________________________________________________________________________________
________________________________________________________________________________
City
______________________________________
State/Zip
__________________________
Telephone No.
(
) ________________________
Fax No. (
) _______________________
Name and contact information of employee authorized to respond to Commission requests.
Name: _______________________________________
Title ____________________________________________
Tel. No.: (
)
________________________________________________________________________________
E-mail Address _____________________________________________________________________________________
Address:
(If different from above.)
Street
________________________________________________________________________________
________________________________________________________________________________
City
____________________________________________
State/Zip ________________________
GPSC Form 500-1
Electronic Version
Revised 9-12-03
1

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