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APPLICATION TO OPERATE A NEW OR RENEWAL …

Black Car / Luxury Limousine New, Renew APPLICATION #:I. BACKGROUND INFORMATION ON BASE STATION FCC Lic. #:Or alternateform of communicationBusiness Type(please check one)CorporationPartnershipSole ProprietorshipIf a Corporation, please list # of shares Authorized: _____; Please list # of shares Issued/ Outstanding: _____24-HourPhone #:Please check one (1):License #:Black Car BaseLuxury Limousine Base II. LUXURY / BLACK CAR ADDRESS This is the address from which you will dispatch vehicles. 1 Mailing Address Line 1:EIN #: or SSN#:Proof of EIN / Social Security No. If a corporation or partnership, you must submit an IRS issued 145-C letter. If a sole proprietor, you must submit proof of social security number. _____(Please enter your current license #. If this APPLICATION for NEW base please leave blank)NEWRENEWALOrName:D/B/A:Email:(requ ired)(All fields in this section must be filled-out completely for your APPLICATION to be processed)City:Zip Code:State:Website Address (required):Address:City:Zip Code:State:Mailing Address Line 2 (if applicable):City:Zip Code:State:LLCAPPLICATION TO OPERATE A NEW OR RENEWAL BLACK CAR OR LUXURY LIMOUSINE BASE STATIONP lease visit schedule an appointment to submit your completed APPLICATION , required documentation and fees via appointment.

Black Car / Luxury Limousine New, Renew Application 5.11.17 Telephone #: I. BACKGROUND INFORMATION ON BASE STATION FCC Lic. #: Or alternate form of

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