Page 14 - Combined_19_OCR

AGENT’S ACKNOWLEDGMENT
RADIO OPERATOR AUTHORIZATION
I HAVE READ AND UNDERSTAND THE TERMS
XYZ BUSINESS COMPANY OF THIS APPOINTMENT AS STATED ON THE
S IG N A T U R E DATE OF ISSUE---------—----------------------- NO---------------------- REVERSE SIDE OF THE AUTHORIZATION CARD.

A G E N T S

AGENT’S SIGNATURE

FILE COPY . FILE COPY
RADIO OPERATOR AUTHORIZATION j RADIO OPERATOR AUTHORIZATION
HAS BEEN ISSUED TO I HAS BEEN ISSUED TO
—1-----------------------------------------------------------------
1 NAME | NAME
1
1
j EMPLOYER
I EMPLOYER
1
1 NUMBER DATE | NUMBER DATE
1 1
1
I ISSUED BY: SUPERVISORY
AGENT | ISSUED BY: SUPERVISORY AGENT
1
1
1 . ... - -
LOCATION 1 LOCATION
1
1
INSTRUCTIONS
1. PLEASE TYPEWRITE OR PRINT IN INK ALL REQUESTED INFORMATION.
O
2. AUTHORIZATION MUST BE VERIFIED BY SUPERVISORY AGENT C FULL SIGNATURE ON
AUTHORIZATION CARD AND INITIALS ON FILE COPYS.
3. FORWARD ONE FILE COPY AND AGENT’S ACKNOWLEDGMENT TO XYZ BUSINESS COMPANY