Designation of RESPORG JYT01. Current Service Information (This MUST match what your provider has on file for you) Company NameCurrent Service AddressCityStateZIPCurrent Billing Telephone Number (BTN)Current Telephone Service Provider Telephone Numbers to Transfer Please enter each Toll-Free number that you would like to port. Should you have over 250 Toll-Free numbers, please input them as a range (8885552100-99). Example: 8005551212 8005551213 Enter numbers to port below (Toll Free Numbers ONLY) Requested Port Date NOTE: Their is no guarantee that your numbers will port the day entered; however, we will request the date entered on your behalf. Weekend ports are not allowed. If the date you enter falls on a weekend, we will assume the following Monday as the requested date. It is important that your telephone equipment is installed and configured prior to the date and time that you select below. Ports will auto-trigger at approximately 11:30 am eastern time. Enter requested port date as month / day / year 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 RESPORG ID JYT01 to be the Responsible Organization (“Resp Org”) for the Toll Free service numbers listed herein: I attest under penalty of law and as an authorized employee, or an authorized representative of the Customer that the Customer is the exclusive end-user subscriber of the Toll Free service number(s) listed above. The Customer assumes all liability for the user (including without limitation, authorized, fraudulent or misappropriated) of traffic of any other end-user subscriber with regards to the Toll Free service number(s) listed. In addition, I understand that the request for a Resp Org change 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 Toll Free service after designating the above as my Resp Org for the Toll Free number(s) listed above. Electronically signed by (type first and last name below)Date signed: (enter today’s date as month / day / year)Your email (you will be emailed a copy of this form) Δ
