Gpsc Form 500-1 - Application For Permit To Use Automatic Dialing And Announcing Devices (Adad) - Georgia Public Service Commission Page 3
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10SECTION II. ORGANIZATION
1. Type of organization:
(a) Individual ...............................................................................................................................................
(
)
(b) Partnership..............................................................................................................................................
(
)
(c) Corporation ............................................................................................................................................
(
)
(d) Other (Specify: ____________________________________________________________)..............
(
)
SECTION III. LOCATION OF ADAD EQUIPMENT
Address:
Street
________________________________________________________________________________
________________________________________________________________________________
City
__________________________________________ State/Zip
__________________________
Number of ADADs to be used by Applicant ______________________________________________________________
EXCHANGE:
Name of Local Exchange Carrier that will provide local service for ADAD(s). _________________________________
__________________________________________________________________________________________________
List all telephone numbers from which ADAD outbound calls will be made. _____________________________________
__________________________________________________________________________________________________
SECTION IV. ADAD EQUIPMENT
List types of ADAD equipment to be used by Applicant (Describe).
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
GPSC Form 500-1
Electronic Version
Revised 9-12-03
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