Ship To Confirmation Contact IDFORM NOT AVAILABLEThis form is only available to customers processing FAA applications through HSE. If you received instructions and a link to this form and you still can not access it, please contact your HSE Sales Representative.Our Current Contact InformationPlease verify / enter / update this information as needed. Below you will be able to provide a different point-of-contact (POC) for specific FAA communications and / or how it will appear on your exemptions / waivers / certificates from the FAA.First Name*Last Name*CompanyStreet*City*State*Country*Zip*HSE needs a specific Point of Contact for all HSE & FAA communications*Is this POC the same as our current contact above? Note that this contact can also be different than what will appear on the official FAA application (see below).YesNoYOUR OFFICIAL POC:Point of Contact for all HSE & FAA communicationsPOC First Name*POC Last Name*POC CompanyPOC Phone*POC Email* POC Addr1*POC Addr2POC City*POC State*POC Zip*Will the POC Contact information above be the same for all OFFICIAL FAA BUSINESS DOCS and APPLICATIONS?*This information will be used on all of your FAA exemptions / waivers / certificates issued during this process.YesNoOFFICAL BUSINESS / NAME & ADDRESS OF APPLICANTHow you want it to appear on your exemptions / waivers / certificates from the FAAFAA Applicant First Name*FAA Applicant Last Name*FAA Applicant PhoneFAA Applicant Email FAA Applicant CompanyFAA Applicant Address*Provide complete address including add1 & 2 (if needed), city, state and zip code.Is your Principal Base of Operations / Main Company Location the same as above?*YesNoPrincipal Base of Operations / Main Company Location:Base Ops CompanyBase Ops Phone*Base Ops Address*Provide complete address including add1 & 2 (if needed), city, state and zip code.OPERATING AS:*-please select-Public / Govt / MilitaryIndividualLLCCorporationPartnershipOtherOther Operation*OVER 55 LBS*NoYesRegistration of Aircraft Over 55 lbs:Your aircraft plus payload will be over 55 lbs. HSE will be filing the necessary paperwork to register your aircraft directly with the FAA. We will provide the registration information directly to you once available from the FAA.LLC Operations Over 55 lbsFor Over 55 lbs and operating as an LLC you must provide 1 of the following docs listed on the FAA's website. Copy and paste the link below into a new tab to access the list.https://www.faa.gov/licenses_certificates/aircraft_certification/aircraft_registry/media/LLCINFO.PDFDoes anybody within your Organization (or an agency you partner w/) currently hold any of the following?*Select All That Apply Airman Certificate (incl Remote Pilot) 137 Certificate Licensed Chemical Applicator COAs Part 107 Waivers Airspace Authorizations Other FAA Exemptions (Please specify) 137 CERTIFICATE NUMBER:*Other FAA*YOUR PILOT CREW:Pilots and Crew that are currently working for you. This can be updated in the future.Pilot / Crew 1 First NamePilot / Crew 1 Last NamePilot / Crew 1 License NumberAdd a 2nd Pilot / Crew Member?* Yes No Pilot / Crew 2 First NamePilot / Crew 2 Last NamePilot / Crew 2 License NumberAdd a 3rd Pilot / Crew Member?* Yes No Pilot / Crew 3 First NamePilot / Crew 3 Last NamePilot / Crew 3 License NumberAdditional Comments or Questions about this form or process?EmailThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.