Letter of Authorization

My signature below certifies that I am the customer of record or the authorized representative for payment for each of the telephone numbers listed below.

For each of the telephone numbers listed herein and on Attachment A, I appoint {{reseller.name|default:""}} (hereinafter "TELCO") to act as my Agent for the purpose of collecting my account information with my current local telephone carrier or provider (hereinafter "Provider").

By selecting TELCO to act as my Agent to research my current services with my current Provider of local telephone service, I am authorizing the change of my local telephone Provider from that/those, which I am currently using to TELCO. This authorization will expire only upon written notification.

LOA Instructions

Only one BTN may be associated with each LOA. If you have additional BTNs, you must submit an LOA for each BTN. Please contact your {{reseller.name|default:""}} representative if you need assistance identifying each BTN.
Please provide a copy of the most recent losing carrier invoice for the BTN listed above (must include ALL pages). The information on this LOA MUST match the losing carrier invoice or Customer Service Records.
Use Attachment A for listing all telephone numbers associated with this BTN.

Please complete the following information

This information MUST match your current invoice and account information

Customer (Company) Name: {{account.name|default:""}}
Service address: {{bill.address|default:""}}
City, State ZIP: {{bill.city|default:""}}, {{bill.state|default:""}} {{bill.zip_code|default:""}}
Account Contact: {{bill.name|default:""}}
Title:
Contact's Number (not BTN):
Contact's Email: {{account.email|default:""}}
Print Name:
Signature:__________________________________________________
Date:________________

{% if reseller.fax_number %}

Please fax this signed LOA to {{reseller.fax_number|default:""}}

{% endif %} {% if reseller.email %}

(please also email a copy to {{reseller.email|default:""}})

{% endif %}

Letter of Authorization

Attachment A

Billing Telephone Number (BTN):

Only one (1) BTN may be associated with each LOA. If you have additional BTNs, you must submit an LOA for each BTN. Please contact your {{reseller.name|default:""}} representative if you need assistance identifying each BTN.

Telephone Numbers to be Ported

Instructions: The numbers listed in this upper table WILL BE PORTED. YOU SHOULD NOT INCLUDE FAX LINES, MODEM LINES, OR ALARM LINES or any line used for non-voice communications. Just include your phone numbers which people use to call you for a voice conversation. If any of these numbers are associated with a DSL line or a Centrex type service, please note that next to the number. It might also help to note any specific use next to the number.

Example: 111-111-1111 DSL Line or 111-111-1111 Main number

Every phone number on the account must be listed either in the upper table TO BE PORTED or in the lower table NOT TO BE PORTED. If you are not sure, please call {{reseller.name|default:""}} to discuss your concern.

List telephone numbers TO BE PORTED

{{n|default:""}}

Telephone Number NOT TO BE PORTED

Instructions: Any numbers listed in this lower table WILL NOT BE PORTED to {{reseller.name|default:""}}'s system and will remain with your existing Carrier. Every phone number on the account must be listed either in the upper table TO BE PORTED or in the lower table NOT TO BE PORTED. If all numbers are not so accounted-for, the porting request will be rejected for inaccuracies.

Note: If your BTN is being ported, then you must identify another number, not being ported, to become the new BTN. If none is selected, we will select one for you. If you are not sure, contact us to discuss your concern.

List telephone numbers here which are NOT TO BE PORTED, one per line. Listing a number as NOT TO BE PORTED will not result in that number being deleted or disconnected. This requires specific orders from the owner to do so. If you have not signed a disconnect order, the lines will not be disconnected!

_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________

{% if qr_code %}

{% endif %}