Non-10DLC Info LOA Form

The undersigned authorized end-user hereby appoints Captivated or its service provider as the Service Registrar for the local or toll-free numbers listed as of the date below and hereby authorizes the Service Registrar to route SMS traffic on the number(s). If necessary, the end-user must contact authorized reseller to release SMS traffic to another provider.

This authorization is valid for 30 days from the date of this LOA.

Please Note* Verizon One Talk hosted numbers cannot be text enabled. Contact our team if you are currrently using Verizon One Talk.

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Consent

consent

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Name

First and Last

Cell Phone

For Submission ONLY (Your cell # will not be shared)

Local Number(s)

List your landline number(s) for hosting here* (or write n/a)

Toll-free Number(s)

List your toll-free number(s) for hosting here* (or write n/a)

Optionally, upload a document with a directory of your numbers

**Please note: If, in the future, you choose to port your current landline(s) or voip line(s) to another carrier (i.e. make a change in phone carriers), your hosted SMS connection will be broken. In the event that you are porting a number(s), please contact our team in advance so that we are aware of the port and can re-host SMS on your line(s) as soon as the port has been completed. In some cases, the new phone carrier might have a block or restriction in place that prevents Captivated from re-hosting SMS on your line(s).

Specify "New Host" or "re-Host"

Specify Account (if applicable)

What the channel should be named? (Channel Title)

Where should the channel be routed? (User or Queue)

Who needs access to the channel? (Sharing)

Additional Notes

Customer Information

Company Name

Company Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Authorized Contact Name

Authorized Customer Signature

I agree to receive text messages from Captivated LLC and am expressly consenting to be contacted at the phone number I provided above. I understand consent is not necessary to purchase goods or services. I may reply STOP at any time to opt-out.