Responsible Organization Designation and Agreement of Agency Toll-Free Service Agreement

Responsible Organization Designation and Agreement of Agency Toll-Free Service Agreement
I designate Iowa Network Services, Inc., doing business as Aureon™ Network Services, (“Aureon”) to act as my agent to transfer Reponsible Organization (Resp Org) functions to Aureon. These designations supercede all prior Resp Org designations pertaining to these numbers. I hereby designate Aureon to act as Resp Org for the following 800/888/877/866/855 service numbers.
Customer Information
Business Name *
Address *
City *
Zip Code *
Current Provider (if applicable) *
Fax Number
Print Authorized Name *
Authorized Signature *

Clear
Date

Month Day Year
Date
If you are transferring service from another provider, please list your name and address as it appears on your current billing statement, or if possible attach a copy of your current billing statement.
Existing Toll Free Number & Points to Number
Existing Toll Free Number 1
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Points to Number 1
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Existing Toll Free Number 2
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Points to Number 2
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Existing Toll Free Number 3
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Points to Number 3
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Existing Toll Free Number 4
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Points to Number 4
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Existing Toll Free Number 5
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Points to Number 5
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Existing Toll Free Number 6
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Points to Number 6
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Existing Toll Free Number 7
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Points to Number 7
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Should be Empty:

Responsible Organization Designation and Agreement of Agency Toll-Free Service Agreement

Customer Information

Existing Toll Free Number & Points to Number