FCC Ship Station Intake Form

Thank you for choosing CVLA to handle your FCC Ship Station License.
Please complete the form below so we can prepare and file your application.
If you already placed an order, use the same name and email so we can match your intake to your payment.

 

  • Contact / Order Info

  • This is for the person CVLA is applying for the license for and the license will have this persons name on it. If you want to have us send it to someone else also please add that in the notes.
  • Please provide the email address you want use to communicate with.
  • Give us your phone number (Cell preferred).
  • Provide the order number you received when you purchased the FCC application if you did.

  • Vessel Information

    Please use the information for the vessel we are applying for.
  • Please provide the vessels registered name.
  • Please provide the vessels registration or main document number.
  • This is the maximum persons you will have onboard.
  • If not know put unknown. But provide the vessel Make and model then.
  • Max. file size: 64 MB.
    Please upload your vessels registration. If you more then one provide the one you want used for this application. US COD or State Registration preferred. If you only have a number for the registration please obtain a copy.

  • Emergency Contacts

    This is the contacts that would be used for the government to contact incase of an emergency. Better to use people that will not be together on the vessel at the same time.
  • Name of the first emergency contact.
  • Name of the second emergency contact.

  • Additional Notes

  • Authorization & Applicant Agreement

  • By signing and submitting this form, I authorize the Commercial Vessel Licensing Authority (CVLA) to prepare, submit, and manage the FCC Ship Station License application for the vessel listed above. I affirm that the information I have provided is true and correct, and I grant CVLA permission to act on my behalf for all FCC filings, correspondence, and processing steps related to this application.
  • Clear Signature