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Teliax Letter of Authorization

End-User Information

Please provide the information requested below. All fields are required.
If you have questions, contact Teliax Support:
1. Authorized User *This question is required.
2. Current carrier account information (if relevant, this is not required or provided by all losing carriers)
3. Service Address *This question is required.
This question requires a valid date format of MM/DD/YYYY.
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.
Signature of