Toll Free RespOrg Change Authorization

Toll Free RespOrg Change Authorization is required for customers that have toll-free numbers. This form grants permission to Servpac to transfer a customer's toll-free numbers from their previous provider.

Please fill out the fields below and make sure all information provided is an exact match from your current carrier. If the information does not match, this can delay or reject the transfer of a customer's toll-free numbers.

Date*

To Whom It May Concern:

I attest under penalty of law, as an authorized agent of the company named below to designate Servpac, Inc. as the RespOrg (Responsible Organization) for each of the toll free numbers specified on this form. I have authority and hereby authorize Servpac, Inc. to arrange with my existing carrier or RespOrg for transfer of each specified toll free number or to provide service on any new toll free numbers requested above. I release any third party from liability for acting in accordance with these instructions

*The name that appears on the customer’s current long distance invoice must match exactly with the customer name entered here. To avoid delays, please have our customer verify this information with their current long distance carrier or request a copy of their invoice to verify the name. The individual representing the company by signing this LOA must be an authorized representative with their current carrier.

Understood and Agreed *:

Company Name*

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

8XX Number*

Toll free number

Ring To Number*

Local ring to number

Current Carrier*

Name of current carrier

Approved By*

First Name

Last Name

Email*

Confirm Email *

Signature*

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Use your mouse or finger to draw your signature above

I acknowledge that Servpac, Inc. is acting as an agent for managing telecommunication services. Servpac, Inc. is providing the network facilities for my telecommunications traffic and is responsible for working with other telecommunications carriers to arrange for the proper porting of telephone numbers. Servpac,Inc. is the entity to whom telephone numbers are legally assigned. I also authorize Servpac, Inc. to act as my agent to notify my local phone company of my decision to change my current long distance service to Servpac, Inc. service. I understand that my local phone company may charge me a fee to switch long distance carriers. Selection of Servpac, Inc. will apply to the telephone number(s) listed on this form. I, the customer, understand that I may designate only one inter-exchange carrier for one telephone number for interLATA and, where applicable, intraLATA usage, and hereby designate Servpac, Inc. as my primary carrier.