Required fields are marked with "*"
COMPANY REPRESENTATIVE INFORMATION
*First Name:
*Last Name:
Title:
*Company:
*Email:
*Phone:
Fax:
Mobile Phone:
Address:
City:
State/Province:
Zip:
Country:
Email Opt Out:
(Check to be excluded from marketing email)
EQUIPMENT DESCRIPTION
Model Name/Number:
Primary Function of Equipment:
*Device Type (e.g. WLAN):
RADIO CHARACTERISTICS
*Transmitter/Receiver Operation:
--None--
Transmitter only
Receiver only
Separate Transmitter and Receiver
Transceiver - Half-duplex
Transceiver - Full-duplex
*Frequency Range:
*Peak Output Power:
*Number of Selectable Channels:
ANTENNA INFORMATION
*Number of Antennas:
Antenna(s) Detachable?:
--None--
Yes
No
OPERATIONAL INFORMATION
*Input Voltage:
AC/DC Converter?:
--None--
Yes
No
TESTING INFORMATION
Testing Required:
(highlight all that applies with CNTRL key)
RF
EMC
Safety
Interoperabiltiy
Applicable Rules/Standards:
(if known)
*Countries/Regions:
(if rules/standards are unknown, highlight all that applies with CNTRL key)
Australia/New Zealand
Canada
Europe
Japan
USA
Other
CERTIFICATION SERVICES
Countries for Certification:
(highlight all that applies with CNTRL key)
* All North America
United States
Canada
Mexico
* All Europe
Albania
Austria
Belarus
Belgium
Bosnia and Herzegovina
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Finland
France
Germany
Greece
Hungary
Ireland
Italy
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malta
Netherlands, The
Norway
Poland
Portugal
Romania
Russia
Serbia and Montenegro
Slovakia
Slovenia
Spain
Sweden
Switzerland
Turkey
Ukraine
United Kingdom
* All Asia
Japan
Australia
New Zealand
Afghanistan
Armenia
Azerbaijan
Bangladesh
Brunei
Cambodia
China
Georgia
Hong Kong
India
Indonesia
Kazakhstan
Korea, South
Laos
Malaysia
Pakistan
Philippines
Singapore
Sri Lanka
Taiwan (ROC)
Thailand
Uzbekistan
Vietnam
* All South America
Argentina
Bolivia
Brazil
Chile
Colombia
Ecuador
Guyana
Paraguay
Peru
Uruguay
Venezuela
* All Central America
Bahamas
Belize
Costa Rica
Dominican Republic
El Salvador
Grenada
Guatemala
Haiti
Honduras
Jamaica
Nicaragua
Panama
* All Middle East
Bahrain
Egypt
Iran
Iraq
Israel
Jordan
Kuwait
Lebanon
Oman
Qatar
Saudi Arabia
Syria
United Arab Emirates
Yemen
* All Africa
South Africa
Algeria
Angola
Botswana
Burundi
Cameroon
Central African Republic
Congo ((Kinshasa)
Congo (Brazzaville)
Côte d'Ivoire
Equitorial Guinea
Ethiopia
Gabon
Kenya
Liberia
Libya
Madagascar
Morocco
Mozambique
Namibia
Niger
Nigeria
Rwanda
Senegal
Sierra Leone
Somalia
Sudan
Swaziland
Tanzania
Tunisia
Uganda
Zambia
Zimbabwe
Prepare application for certification?:
--None--
Yes
No
Submit Application for Certification?:
--None--
Yes
No