MCN LOA Client Form

MCN LOA Client Form

This is a Letter of Authorization (LOA) to transfer your telephone number(s) from your current provider. Please upload a recent bill, enter all required information, and sign below.
Upload a copy of your current phone bill (not older than 30 days, optional, but may expedite your request).

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The following information MUST match exactly what your current provide has on file for you. If this information does not match, your port will bedelayed.
Company Name
MUST match information your provider has on file
Service Address - Street Address
Service Address - City
Service Address - State
Service Address - Zip Code
Account # at Losing Provider Service
Port-Out PIN, if any
REQUIRED if you are porting from .................
Telephone Number(s) to Transfer
Enter one number per box with no punctuation. Example 5555555555
Telephone Number to Transfer
Telephone Number to Transfer
Requested Port Date (Earliest date you would like your number ported. A Minimum of 4 Business Days, No Holidays or Weekends. This date is not guaranteed; we will not request a port prior to the date specified.)

MonthDayYear
Date
I designate MCN Online or its designated agent to transfer my telephone number(s) from my current provider to MCN Online. I authorize MCN Online to obtain

billing information, customer service records, and any other information that will aid in transferring my telephone number(s) to MCN Online.

As the end-user subscriber, or the authorized representative of an end-user subscriber of certain Toll Free service numbers (the "Customer"), I hereby authorize

MCN Online and its designated agent(s) to be the Responsible Organization ("Resp Org") for the Toll Free service numbers listed herein.

I understand that this request does not constitute an order for disconnect of service with my existing carrier(s). I, on behalf of the Customer, continue to accept

responsibility for notifying my existing carrier(s) of any intention to disconnect and/or change my service after designating the above as my new provider.
Your Email Address
example@example.com
Authorized By - First Name
Authorized By - Last Name
Authorized Signature
Should be Empty: