Letter of Authorization (Keep My Phone Numbers)

Company Name *_ Required

Authorized Contact Name *_

First Name

Last Name

Service Address *_

Street Address

Address Line 2

City

State/Region/Province

Postal / Zip Code

Authorized Signer's Email *_ Required

Desired Port Date *_ Required

MM/dd/yyyy Must be at least 10 business days from today.

Are you porting ALL numbers associated with this account? *_ Required

Yes No

Are we porting more than 6 Numbers?

Yes No

Field(s) inside the grid are incomplete or invalid. Expand the grid to review them.

File Upload ( Download Template)

Upload file

Choose File(s)

Include a CSR from your current carrier or spreadsheet. IMPORTANT: If you are porting numbers across multiple accounts and/or locations, please include account number and physical location columns in your data.

Phone 1 *_ Required

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Phone 2

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Phone 3

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Phone 4

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Phone 5

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Phone 6

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Field(s) inside the grid are incomplete or invalid. Expand the grid to review them.

Current Service Provider *_ Required

Account Number *_ Required

Billing Telephone Number (BTN) *_ Required

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Important Service Warnings *_ Required

DO NOT CANCEL YOUR SERVICE: Do not call your current provider to cancel service before the port is complete. If you cancel early, you may lose your phone numbers permanently.

SCHEDULING: We will contact you via email when a firm number transfer date has been scheduled.

I understand.

Authorization & Disclaimer *_ Required

By signing below, I verify that I am, or represent (for a business), the above-named local service customer, authorized to change the primary carrier(s) for the telephone number(s) listed, and am at least 18 years of age. The name and address I have provided is the name and address on record with my local telephone company for each telephone number listed.

I authorize Amplifire Inc or its designated agent to act on my behalf and notify my current carrier(s) to change my preferred carrier(s) for the listed number(s) and service(s), to obtain any information Amplfire Inc deems necessary to make the carrier change(s), including, for example, an inventory of telephone lines billed to the telephone number(s), carrier or customer identifying information, and billing addresses.

I understand and agree.

Signature Date *_ Required

MM/dd/yyyy