Termination Pending - Pleading Form

Call Sign*
Name of Licensee*
First Last
Mailing Address*
Street Address Address Line 2 City State ZIP Code
Phone Number*
Fax Number
Email*
Additional Information and Comments
Attach Copy of Pleading Letter*
Accepted file types: pdf, doc, tiff, docx, xls, Max. file size: 8 MB.
Signor Name*
Signor Title*
Privacy*
- YES, I have read and accept the data usage terms and agree to APCO’s use of my personal information. *