Application for License of Radiation Machine (Ionizing)

Facility Information
Refer to the legal title and/or administrative control of the radiation machine.
Do you have a DBA (Doing Business As) name?
Select type of ownership:
Contact Information
Facility Contact
Physical Address
Mailing Address
Is your mailing address different from the address above?
Type of Facility
Please select the type of facility according to its primary usage: