| * Program Code or Name: | Please separate multiple codes with a comma. |
| * Applicant Type: | Company Individual |
| * Company Name: | |
| * Representative concerned: | |
| * First Name: | |
| * Last Name: | |
| * Address: | |
| * Region/Province: | |
| * ZIP: | |
| * Country: | |
| * Telephone: | e.g. 999-999-9999 |
| Fax: | e.g. 999-999-9999 |
| * E-mail: | |
| * Type of use: | |
| | Other |
| Intended area: | e.g. Broadcasting area; Required for business use only |
| Intended time period or frequency of use: | |
| * Method of Payment: | |
| | Other |