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

MonthDayYear
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