Attachment FCC FORM 159

This document pretains to ITC-214-20091201-00520 for International Global Resale Authority on a International Telecommunications filing.

IBFS_ITC2142009120100520_784259

READ INSTRUCTIONS CAREFULLY Approved by OMB BEFORE PROCEEDING FEDERAL COMMUNICA TIONS COMMISSION 30601589 REMITTANCE ADVICE Page No_1 ofl_z FORM 159 {1}LOCKBOX # 979093 SECTION A — PA YER INFORMATION mamemmmman wenmnmmmmmmmmscmeems omm m = w manas» wone (2) PA YER NAME (if paying by credit card enter name exactly as it appears on the card) ~*~_~| (3) TOTAL AMOUNT PAID (U5. Dollars and cents) Airus Telecom Inc. $1,015.00 emmimmmemmmom a= a nam uc mumess mrmnsns nmas == (1) STREET A DDRESS LINE NO1 80 S.W. 8th Steet, Suite 2000 (5) STREET ADDRESS LINE NO. 2 (6) CITY (7) STATE (8) ZIP CODE Miami FL 33130 3038 (9) DAYTIMETELEPHONE NUMBER (includearea code) (10) COUNTRY CODE (if not in U.S.A.) +1 (305) 3567666 [—= emam omm (11) PAYER (FRN) FCC REGISTRATION NUMBER (FRN) REQU-IRED ~(12)FCC USEONLY ommnmmmmmmnnremmmmmm n mmmmnemmmmammmme] 0019160449 IF MORE THAN ONEAPPLICANT, USE CONTINUATION SHEETS (FORM 159—C) _ COMPLETE SECTION BELOW_FOR EACH SERVICE, IFMORE BOXES ARE NEEDED, USE CONTINUATION SHEET (13) APPLICANT NAME ["T12) STREET ADDRESSLINE NO1 (15) STREET ADDRESS LINE NO. 2 (16) CITY (17) STATE (18) ZIP CODE omm was ~= (19)DA YTIMETELEPHONE NUMBER (nclude area code) (20) COUNTRY CODE (if not in U.S. A.) es marue FCC REGISTRATION NUMBER (FRN) REQUIRED nom — (21) APPLICANT (FRN) (2Z)FCC USE ONLY COMPLETE SECTION C FOR EACH SERVICE, IF MORE BOXES ARE NEEDED, USE CONTINUATION SHEET (23A) CALL SIGN/OTHER TD (24A) PAYMENT TVPE CODE (25A) QUANTITY 0019160449 CUT 1 (26A}) FEE DUE FOR (PTC) (27A) TOTAL FEE FCC USE ONLY $1,015.00 $1,015.00 (28A) FCC CODE 1 (29A) FCC CODE 2 (23B) CALL SIGN/OTHER ID (24B) PAYMENT TVPE CODE (25B) QUANTITY (26B) FEE DUE FOR (PTC) (278) TOTAL FEE FCC USE ONLY (28B)FCC CODE I (29B) FCC CODE 2 SECTION D — CERTIFICATI0N T CERTIFIEATIQN STATEMENT 1. ZH b1 &7 . certify under penalty ofperjury thai the Foregoing and supporting informationis true and correct to the best of my knowledge. information and belief sIGNATURE Z@flf/,@&‘Qg@géf/zi_éo DATE ///30/ZWQ5 ‘ SECTIONE — EDIT CARD PAYMENT INFORMATION MASTERCARD______ VISA______— AMEX_____ DISCOVER__ ACCOUNT NUMBER EXPIRATION DATE ______ 1 hereby authorize the FCC to charge my credit card for the service(sYauthorization herein described. SIGNATURE_____ DATE _ SEE PUBLIC BURDEN ON REVERSE FCC FORM 139 FEBRUARY 2003


Document Created: 2009-11-30 14:01:14
Document Modified: 2009-11-30 14:01:14
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