Letter of Authorization Hosted SMS Consent Business Name * Name * Name First First Last Last Phone Number to be Hosted with MyRepChat * Users Email Address used for your MyRepChat Account * Current telephone provider associated with this number: * If user is requesting more number, please enter them here separated by "," Address * Address Address Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal TERMS AND CONDITIONS By signing the below, I verify that I am, or represent (for a business), the above-named service customer, authorized to change the SMS 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 ionlake, LLC., or its designated agent to act on my behalf and notify my current carrier(s) to change my SMS carrier(s) for the listed number(s) and service(s), to obtain any information ionlake, LLC. 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, billing addresses. Consent * I have read, understand, and voluntarily agree to take part in this training. Participant's Signature * signature keyboard Clear Date * Submit Start Over If you are human, leave this field blank.
