800 Resporg Authorization KSW01

Responsible Organization Letter of Authorization

800 Resporg Authorization KSW01
CUSTOMER INFORMATION

(AS IT APPEARS ON CUSTOMER'S BILL COPY)
Company Name
Company Address

Billing Address

Street Address Line 2

City. State, ZipState / Province

Postal / Zip Code
Company Phone
Billing Phone NumberFormat: (000) 000-0000.
Contact Name
Contact Phone
Please enter a valid phone number.Format: (000) 000-0000.
Billing Account Number
As it appears on your bill.
Delivery Date

MonthDayYear
APPLICABLE TOLL-FREE NUMBERS AND INFORMATION
CURRENT CARRIER
New Resp Org ID: KSW01

Enter Toll-Free Numbers Below

Rows	Enter Valid Phone Number Below
Toll Free # 1
Toll Free # 2
Toll Free # 3
Toll Free # 4
Toll Free # 5
Toll Free # 6
Toll Free # 7
Toll Free # 8
Toll Free # 9
Toll Free # 10
Toll Free # 11

CUSTOMER AUTHORIZATION APPOINTMENT OF AGENT

The undersigned customer ("Customer") hereby appoints CoreDial, LLC. ("CoreDial") to act as its authorized agent for all matters pertaining to the 8YY services listed above. This agency includes the ordering of rearrangement of services, assignment to primary carrier services requests, disconnection of service and other requests as deemed necessary by CoreDial to implement the 8YY services ordered from CoreDial and itemized on Customer's Service Order Form(s) and associated attachments. This authorization will expire upon written notification only.
Customer
Signature*

Clear
Printed Name
Date Signed

MonthDayYear
Confidential and Proprietary
Maine Technology Group | 15 Evergreen Dr, Oakland ME 04963 | (207)692-0955

www.mainetechgroup.com
Should be Empty:

Responsible Organization Letter of Authorization