CCN New Customer Application
Today's date
*
Agency type
*
First Responder
School District
Public Utility
General Government
Other
Agency Name
*
Physical street address
*
City
*
State
*
Zip Code
*
Point of Contact (POC)
*
POC e-mail address
*
POC Phone Number
*
Operational Service Area
*
Operational required hours of service
*
24/7/365
other
If other selected, provide number of days per year
*
If other selected, provide number of hours per day
*
Need to communicate with your local Dispatch?
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Yes
No
Number of portable radio subscribers
*
Number of mobile radio subscribers
*
Do you have any security requirement for voice communications?
*
AES Encryption
DES Encryption
N/A
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