Authorized Representative Form

Appointment of an authorized representative
If you wish to appoint an Authorised Representative to deal with EkoDial Wholesale account on your behalf, please:

Carefully read the important notes below;
Carefully complete the form on the next page;
Scan the form and email it to us at support@us.EkoDial.online.

Important notes:
1. What is an Authorised Representative?
An ‘Authorised Representative’ appointed can deal with EkoDial Wholesale on your behalf as your agent (including making a complaint) and:

if you give the appointed Authorised Representative limited rights: they only have those rights including any limitations you specify on access to your information; and
If you do not give limited rights: the appointed Authorised Representative has the power to act and access information as if they are you, including the change of services, subscriptions and account details.

2. We may also accept a person who holds an appropriate Power of Attorney or Guardianship Order as an Authorised Representative for the customer account owner. Please forward a certified copy of the Power of Attorney or Guardianship Order together with this form (signed by the Attorney or Guardian for the customer account owner). We may need to have the documents checked before we can accept the appointment.

Customer’s company name

Customer’s account number

The person I appoint

Their email address

Their landline number

Their mobile number

Address

Street Address

Street Address Line 2

CityState

Zip CodeCountry

Limitation/s on the authority of Authorised Representative (if applicable)

Appointment and authority:

I authorise EkoDial Wholesale to deal with the above person as my Authorised Representative. I acknowledge responsibility for anything my Authorised Representative does on my behalf within their authority as described in this Appointment. I release EkoDial Wholesale from any claim I might otherwise have against EkoDial Wholesale, based on anything you do in reliance on this Appointment. You may assume that you are dealing with the relevant person if they identify themselves as such when you contact any of the contact numbers/addresses above. The appointment continues until I revoke it in writing. pointment and authority:

Representative’s full name

Representative’s signature

Date signed

Date

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