Teliax Letter of Authorization

Please provide the information requested below. All fields are required.
If you have questions, contact Teliax Support:
help@teliax.com
+1-303-629-8300

1. Authorized User *This question is required.

End-User or Business Name
Person authorized to make this request
Teliax Account Number
Email Address

2. Current carrier account information (if relevant, this is not required or provided by all losing carriers)

Account/Customer Number
Porting PIN/Password

3. Service Address *This question is required.

Street Address
Address (cont.)
City
State
ZIP

4. Date of this request *This question is required. This question requires a valid date format of MM/DD/YYYY.

calendar

5. Authorized End-User Signature *This question is required.I understand I am signing this document electronically and that by doing so, I am affirming that I am authorized to request this change and have read and agree to the electronic signature provisions of the Teliax LNP documentation.

Clear

Signature of

6. I have read and agree to the terms outlined in the Teliax LNP documentation (available here.)
I understand that if my port completes, I will be charged $25 per block of 10 ported numbers. *This question is required.

I understand and agree to these terms.

Teliax Letter of Authorization

End-User Information