E-sign LNP Authorization Form

The undersigned does hereby appoint VoIP Route as the Responsible Organization for the number(s) listed below. VoIP Route may order new service, change exisiting service & request carrier information. This authorization shall remain in effect until further written notice is provided.

Current Service Provider Name *

Obtained from phone bill

Current Service Provider BTN *

Obtained from phone bill

Current Service Provider Account # *

Obtained from phone bill

Billing Account Name *

Obtained from phone bill

Authorized Account Holder *

Authorized user name

Billing Address *

Street Address

Street Address Line 2

City State

Zip Code

Service Address is different than billing address? *

Yes No

Service Address

Street Address

Street Address Line 2

City State

Zip Code

Contact Number(s) *

Please enter a number(s) we may reach you for questions

Contact Name *

Please enter full name

E-mail for notifications *

Used for status updates and never shared

Main number to be ported & associated with Caller-ID, e411 & e911 (must be associated with the BTN listed above) WHEN ONLY PORTING FAX NUMBERS ENTER 000-000-0000 *

Enter your main number

Name for Caller-ID *

15 character limit for Caller-ID

Are you porting additional Non-Fax number(s)? *

Yes No

Additional number(s) to be ported (must be associated with the BTN listed above)

	Number	Number	Number	Number	Number	Number
Porting
Porting
Porting
Porting

Are you porting a Fax number(s)?

Yes No

Fax number(s) to be ported (must be associated with the BTN listed above)

	Number	Number	Number	Number	Number	Number
Porting
Porting
Porting
Porting

Complete or Partial port *

Complete - ports ALL existing numbers from your current provider Partial - leaves some numbers with your current provider & account

By submitting this request I certify the above information is accurate and authorize VoIP Route to port my number(s). I also understand that any charges incurred to port number(s) are my responsibility and not VoIP Route's. *

In order to process this request you must submit a current bill with the BTN clearly visible. *

Signatory Name (printed): *

Printed full name of authorized signer

Signatory Title: *

Authorized signers work title or position

Date *

Month Day Year

Electronic Signature (legally binding). Your IP address is associated with your authorization. *

Please use your mouse or stylus to create a signature above Clear

For questions, please contact [email protected] or call 305-602-3780

*

Please attach your most recent bill *

Upload a File

Attach scanned copy of recent phone bill

LNP Letter of Authorization