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FCC License Application Worksheet 

The FCC requires all applicants to furnish the information requested on this worksheet. The FCC will charge your credit card $205 for the Ship Station License (valid for ten years), and $55 for the Restricted Radio Operators Permit (valid for the life of the holder). This worksheet is available in PDF format by clicking here, or you can print this, the Internet version. Mail the completed worksheet, along with a check for the $75 processing fee to:

Dockside Radio
1368 Willet Court
Punta Gorda, FL 33950

 Note: By clearly printing the requested information in the spaces provided you are helping to ensure that your application will be processed as quickly and accurately as possible.  

1. Licenses Applied For (check either one or both): Ship Station License/Call sign:____ Restricted Radio Operators Permit:___

2. If you are registered in the FCC Universal License System, or have been assigned a FRN number by the FCC, enter the ULS password or the FRN number & password, otherwise leave blank:

FRN Number:______________________________ FRN Password:________________________________

3. Current FCC licenses and call signs held by you (attach an additional sheet if necessary):

 License type/class____________________________ Call sign:________________________________
MMSI Number (if assigned)____________________  

4. Your Name:_________________________________________________________________________________ 

5. Street Address:_______________________________________________________________________________ 

6. City:________________________________________________ State:_______Zip:________________________ 

7. Social Security Number:________- ______ - ___________   Date of birth:__________________(mm / dd / yy) 

8. Telephone Number: (______) ______ - ___________ E-mail Address:__________________________________ 

9. Boat Name:___________________________________________________________________________  

10. Documentation/registration #____________________________________________________________ 

11. Credit Card Number:__________________________________________ Security Code1________________          

12. Credit Card Type (MasterCard, Visa, etc.):___________________________ Exp. Date: ________________(mm / dd / yy)

13. Name exactly as it appears on the card: __________________________________________________________

This section for office use

Date filed with FCC:_________________   Date FCC Issued License:___________________

Ship Station License FCC File #: _________________  Operator Permit FCC File #: ____________________

Call sign issued:____________________  MMSI number issued:___________________________

Electronic filing fee paid to DSR: Cash / Check Number:______________ Date:____________

1 The Security code is the last three numbers printed on the signature block on the back side of your card.


DockSide Radio will provide you with the following:
1. Copy of your registration with the FCC filing system.
2. Printed receipts from the FCC detailing the FCC charges for the license filing(s).
3. Printed reference copies of the license(s) granted by the FCC.

Note: The FCC will mail the actual license to your mailing address in one to three weeks from the date the licenses were granted.

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