By signing below, I certify that all information provided is true, accurate, and complete. I authorize Surge.ai and Go Surge LLC to collect, process, store, transmit, and submit this information to telecommunications carriers, aggregators, campaign registries, messaging platforms, regulatory bodies, and compliance verification services for brand registration, campaign registration, and messaging compliance. This authorization remains in effect until revoked in writing. I agree to indemnify and hold harmless Go Surge LLC from any claims or liabilities related to the A2P 10DLC registration process. I confirm compliance with TCPA, CAN-SPAM, FCC, CTIA, and all carrier policies.

By signing below, I, the undersigned authorized representative of the above-named organization, hereby certify that all information provided in this form is true, accurate, and complete to the best of my knowledge and belief. I understand that any misrepresentation or omission of material facts may result in the denial, suspension, or revocation of brand registration or messaging services. I hereby authorize Surge.ai, its affiliates, successors, assigns, and designated agents (collectively, 'Authorized Parties') to collect, process, store, transmit, and submit the information provided herein to any and all third parties, including but not limited to telecommunications carriers, aggregators, campaign registries, messaging platforms, regulatory bodies, compliance verification services, and any other entities deemed necessary by the Authorized Parties, for the purposes of brand registration, campaign registration, messaging compliance verification, carrier vetting, identity verification, and any related regulatory or compliance processes. I further acknowledge and agree that: (a) the Authorized Parties may share this information with additional third-party service providers, partners, or subprocessors as reasonably necessary to fulfill the purposes described above; (b) the submission of this information to third parties is subject to such third parties' own terms, policies, and privacy practices; (c) the Authorized Parties shall not be liable for any actions taken by third-party recipients of this information; and (d) this authorization shall remain in effect until revoked in writing by the undersigned. To the fullest extent permitted by applicable law, I waive any and all claims against the Authorized Parties arising from or related to the transmission, disclosure, or use of the information provided herein by any third-party recipient. I agree to indemnify, defend, and hold harmless Go Surge LLC, its owners, officers, directors, employees, agents, affiliates, successors, and assigns from any and all claims, damages, losses, or liabilities. Go Surge LLC shall have no liability whatsoever for any damages related to the A2P 10DLC registration process, campaign approval/rejection, message delivery, carrier filtering, or campaign suspension. I assume all risk and confirm compliance with TCPA, CAN-SPAM, FCC, CTIA, and all carrier policies.

By submitting this form, you authorize Go Surge LLC to create and utilize pre-made/pre-filled campaign registration information provided by our carrier and aggregator partners on your behalf. Campaign details, sample messages, and content attributes above may be adjusted by Go Surge LLC to meet carrier and registry compliance requirements.