DIGITAL FREQUENCY COORDINATION REQUEST FORM 1. Band: 2. Output Freq: 3. Input Freq: 4. City: 5. Alias: 6. Callsign: 7. Location: 8. Region: 9. County: 10. Baud: 11. System Type: 12. Network Type: 13. Software Type: 14. IP Address: 15. FQDN: 16. Latitude: 17. Longitude: 18. Mountain Top: 19. Freq 2: 20. Freq2 BAUD: 21. Freq 3: 22. Freq3 BAUD: 23. Freq 4: 24. Freq4 BAUD 25. Power Out: 26. Emission: 27. Ant Type: 28. Ant Gain: 29. Ant Bearing: 30. Ant Polarity: 31. Ant Height: 32. Ant Elev: SPONSOR INFORMATION 33. Name: 34. Callsign: 35. Address: 36. City: 37. State: 38. Zip: 39. Phone: 40. E-Mail: OWNER INFORMATION 41. Name: 42. Callsign: 43. Address: 44. City: 45. State: 46. Zip: 47. Phone: 48. E-Mail: CONTACT INFORMATION 49. Name: 50. Callsign: 51. Address: 52. City: 53. State: 54. Zip: 55. Phone: 56. E-Mail: SITE OWNER INFORMATION 57. Site Owner: SUBMITTER INFORMATION 58. Submitter: 59. Callsign: 60. Phone: 61. E-Mail: 62. Remarks: 63. Signature: 64. Date: Submit completed FORM, or questions, to: packet@azfreqcoord.org