Form

Company Info

Company Name and Legal Name:

Entry Type

Corporation

Individual

Partnership

LLC

Other

Types of Business

Outbound

Inbound - Provide Percentage of Mix

Business Description - Provider Type:

Call/Contact Center

Wholesale Carrier

Query Info

Using Auto Dialer?

Yes

Agent Count:

Campaign 1:

Campaign 2:

Campaign 3:

Do you need IP to IP:

Yes

Write IP:

Data Type:

Raw

Opt-in

None

*Disclaimer: ONLY OPT-IN data is applicable with our predictive dialer as per TCPA & TSR regulations

Referrals

Referred by:

Company Name:

Contact Info

Full Address - (Headquarters or Main Location):

Contact Number:

Email:

Industry Questions

Do you have a Subscription Account Number for accessing the National/Federal Do Not Call Registry?

Yes, please provide Account Number

Account Number for DNC Registry:

Does your business have any certifications that permit or allow pre-recorded messages to be delivered to your customer base?

Yes, please attach copy of certificates

Does your company initiate or transport robocalls calls within, to or from the United States?

Yes

Do you plan on buying Telephone numbers/CLI's?

Yes

Already have virtual number

Does your company have a U.S. Bank Account(s)?

Yes, please provide the following

Bank Name:

Bank Routing Number:

Bank Account Number:

Paypal:

Customer will comply with all applicable laws, statutes, rules and regulations including, but not limited to, the Telephone Consumer Protection Act (TCPA), codified at 47 U.S.C. § 227, the FCC’s Rules implementing the TCPA, codified at 47 CFR § 64.1200, et seq, and the Telemarketing Sales Rule (TSR), codified at 16 CFR 310. An electronic copy of these documents will be provided to Customer upon request. TVS Networks, LLC. (“TVS”) may cease or terminate service to Customer without notice for incorrect or false responses to this document. Customer will indemnify and hold harmless TVS and its affiliates, officers, agents and employees from and against any claims, losses, penalties, fees and/or damages that TVS incurs due to Customer’s violation of the TCPA, TSR and other applicable laws, rules and regulations.

The signatory below represents and warrants that he/she has full capacity and authority to sign on behalf of Customer.

Customer Name:

Signature:

Printed Name:

Title:

Date:

Know your customer