User's Manual

Timco Engineering, Inc.
TCB Application Form 731
Rev 22 June 2004
Shaded areas are REQUIRED
Item 1. Applicant’s complete, legal business name:
Surecom Technology Corp.
Applicant’s FCC Registration Number (FRN): 0010870236
Item 2. Applicant’s mailing address: fill in fields, as appropriate
Line 1: 6F, No. 125, Sec. 2, Datung Rd., Shijr City,
Line 2:
P.O. Box:
City: Taipei
State: Country (if foreign address):
Taiwan
Zip/Postal Code:
221
Item 3. Applicant Contact Person:
First Name: Paul Last Name: Shih
Title: Telephone: [phone]
E-mail: [e-mail]
Fax No.: 886-2-86926203
Item 4. FCC ID
consisting of:
Grantee Code:
MP3
Equipment Product Code (14 characters maximum):
-9101G-0504 include “dashes” (-) where appropriate
Item 5. Application Contact:
All questions regarding the application will be directed to this contact. The Original
Grant and Invoice will be sent to this contact.
Firm Name:
Spectrum Research & Testing Lab.
Telephone:
[phone]
Ext: Fax: No.:
[phone]
First Name: Johnson Middle Initial: Last Name: Ho
Address Line 1: No. 101-10, Ling 8, Shan-Tong Li, P.O. Box:
Address Line 2: City: Chung-Li, Taoyuan State:
Country (if foreign address): Taiwan, R.O.C. Zip/Postal Code:320
E-mail: [e-mail]
Telephone:[phone] Fax:[phone]
Item 6. Test Firm Used to Take Measurements:
Firm Name:
Spectrum Research & Testing Lab.
Telephone:
[phone]
Ext.: Fax No.:
[phone]
First Name: Johnson Middle Initial: Last Name: Ho
Address Line 1: No. 101-10, Ling 8, Shan-Tong Li, P.O. Box:
Address Line 2: City: Chung-Li, Taoyuan State:
Country (if foreign address): Taiwan, R.O.C. Zip/Postal Code: 320
E-mail: [e-mail]
FCC Registered Test Site Number. Required for Part 15 and 18 applications.
Item 7.
* Does this application include a request for SHORT-TERM confidentiality for any portion(s) of
the data contained in this application pursuant to FCC DA 04-1705 dated 6/15/2004?
* Does this application include a request for confidentiality for any portion(s) of the data contained
in this application pursuant to 47 CFR 0.459 of the Commission Rules?
SHORT-TERM request:
Yes No
PERMANENT request:
Yes No
Item 8. *Is this application for modular approval? Yes No
If yes, please submit a cover letter addressing the modular approval requirements of DA 00-1407.
Item 9. *Is this application for software defined radio authorization? Yes No
Item 10. Equipment Class: 3-digits required
DTS
Description of Product as it is marketed:
802.11g 54M Wireless LAN Media Adapter
For Timco Use Only
Job Number 1147TC5
Scope A-4
Date Filed 06/08/05
Conf. # TC692258
Grant Note
PWER LISTED &
CONDUCTED + “F”