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
Applicants Name
First Last
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.
Email Address*
Enter Email Confirm Email

Please provide the email address you want use to communicate with.
Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Phone Number*
Give us your phone number (Cell preferred).
Order Number
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.
Vessel's Name*
Please provide the vessels registered name.
Vessel Type*
Registration / Doc Number*
Please provide the vessels registration or main document number.
Maximum Persons Onboard*
This is the maximum persons you will have onboard.
Gross Tonnage*
If not know put unknown. But provide the vessel Make and model then.
Upload Vessel Registration
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.
Emergency Contact 1*
First Last
Name of the first emergency contact.
Address (Emergency Contact 1)*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone (Emergency Contact 1)*
Email (Emergency Contact 1)*
Emergency Contact 2*
First Last
Name of the second emergency contact.
Address (Emergency Contact 2)*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone (Emergency Contact 2)*
Email (Emergency Contact 2)*
Additional Notes
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.
Applicants Signature*

Contact / Order Info

Vessel Information

Emergency Contacts

Additional Notes

Authorization & Applicant Agreement

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