For TFs release to RESPORG ID: QIT01
Letter of Agency (LOA)
This letter authorizes Telnyx to initiate a port request. All information must be entered exactly as shown on the customer service record (CSR) of the current carrier. In addition to completing this form, you will need to provide a copy of your latest bill/invoice.
Account or Company Name:*
From The Customer Service Record (CSR)
Address
Use the Service Address, not the Billing Address (unless they are the same) Street w/ Number (Required for Toll Free #s): City
Street Address Line 2
City State/Province
Zip/Postal Code
Use the Service Address, not the Billing Address (unless they are the same) Street w/ Number (Required for Toll Free #s): City:
Current Carrier Information
Carrier Name:*
Billing Telephone Number (BTN):*
Numbers to Be Ported: Separate with commas. For ranges, use a dash (i.e. 2163215000-2163215999). Please make a note below if you are attaching a separate list of numbers.*
This Letter of Agency (“LOA”) hereby authorizes release of all customer proprietary network information (“CPNI”), as defined in 47 U.S.C. §222, to Telnyx LLC. Such CPNI shall include but not be limited to customer name and number, billing records, service records and network and equipment records for the purpose of providing telecommunications or information services. This LOA will become effective on signature date and will remain in effect unless revoked in writing prior to that date. 1.Parties acknowledge that [Your Company Name] has obtained customer proprietary network information (“CPNI”) as that term is defined in 47
U.S.C.§222.
2.[Your Company Name] authorizes Telnyx to use, disclose or access such CPNI as needed for the provision of telecommunications services to [Your Company Name]’s end user customers. Such use and disclosure includes, but is not limited to, population of CNAM databases by third party providers. 3.Parties acknowledge that pursuant to 47 C.F.R. §64.2005, [Your Company Name] may use, disclose, or permit access to CPNI for the purpose of providing service without authorization from its customers. 4.[Your Company Name] agrees that it will not require Telnyx to use, disclose or access CPNI for any reason other than for the provision of telecommunications or information services, as provided in 47 C.F.R. §64.2005(a). To the extent that Telnyx’s performance of this Agreement includes activities outside the scope of those permitted in 47 C.F.R. §64.2005(a), [Your Company Name] will provide Telnyx with any necessary written customer authorization for the use, disclosure or access to CPNI prior to Telnyx’s performance of those activities. 5.Telnyx agrees to take all reasonable steps to protect CPNI provided to it by [Your Company Name] in compliance with 47 U.S.C. §222.
Authorized Signature:
Print Name:*
Date:*
Month Day Year
Date
Please Note: For Toll Free numbers the signature is visually compared to what is on file and must match exactly
All fields must be completed. Any invalid or missing information will result in delays and/or rejected orders.
Letter of Agency
311 W. Superior St – Suite 504 Chicago IL 60654 312-945-7420 – porting@telnyx.com
Version 2.2 June 2017
Should be Empty:

Letter of Agency (LOA)

From The Customer Service Record (CSR)

Current Carrier Information