Bring Your Own Number Letter of Authorization
This letter allows PracticeMarketer to add text messaging (SMS) and picture messaging (MMS)capabilities to your existing +1 country code standard and/or 8XX Toll-Free number(s) without porting those numbers to the PracticeMarketer network by authorizing PracticeMarketer as the messaging carrier for the number(s). The messaging will run with our APIs and applications while the voice channel will continue to run with your existing voice carrier/phone service provider.
1. Customer Info
This name associated with the telephone number should appear exactly as it does on your primary carrier or number provider telephone bill.
Name
First Name
Last Name
Business Name
Email
example@example.com
Contact Phone Number
-
Area Code
Phone Number
2. Service Address
This is the address on file with your current carrier. Please note that this must be a physical location and cannot be a PO box.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
3. Telephone Numbers
List all telephone numbers which you authorize to text enable with PracticeMarketer as the messaging carrier. The service/number provider information is requested to assist with resolution in the event that there is an issue with text enabling.
Phone And Provider
Rows
Phone Number
Provider for this line
#1
#2
#3
#4
#5
4. Authorization
By signing this Letter of Authorization, (“Customer”) acknowledges and agrees to allow PracticeMarketer, Inc. (“PM") and its partners and/or affiliates to undertake interoperability for Short Message Service (SMS) and/or Multimedia Messaging Service (MMS) –collectively referred to herein as “Messaging” – provisioning and routing related to the telephone numbers (“TNs”) listed above or attached. Customer agrees to allow PM to work with industry service provider(s) to perform necessary provisioning services for the above or attached TNs associated with Customer solely for the purposes of (a) sending or receiving messaging, and (b) publishing such TNs for routing and registry visibility to other carriers and service providers. This authorization is expressly limited to this purpose for Messaging only, and not for voice services. As part of this agreement, Customer shall be responsible for providing PM exclusive rights to operate this service until service is requested to be cancelled via email to webmaster@practicemarketer.com. This LOA must be signed by the Authorized party on Customer’s account or by a person who has the authority to act as a legal agent for Customer and is only valid for thirty (30) days from the date of signature.
Signature
Type Full Name
First Name
Last Name
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Should be Empty: