Service Establishment Application

Step 1

Step 2

Step 3

Step 4

Step 5

Step 6

Step 7

Company Information

Resp Org SCP

Company Name*

Trouble Referral Number
(Contact Phone Number) *

Street Address *

Street Address 2

City*

State/Province*

Zip/Postal Code *

Company Email*

I consent for Somos to complete a background and/or credit check, prior to establishing my Resp Org.

A W-9 is required to submit this request. Add W-9 Attachment: *

First Login ID

Same as Company Address

First & Last Name *

Email *

Street Address *

Street Address 2

City*

State/Province*

Zip/Postal Code *

Telephone *

Fax

Four Digit Security Pin *

	I understand that an additional tariff fee will be applied for the creation of each Login ID.

Billing Contact
Same as Company Address

Primary Billing Contact Name *		Street Address 2

Street Address *		State/Province

City*		Telephone*

Zip/Postal Code *		Four Digit Security Pin *

Email *

Alternate Billing Contact
Same as Company Address

Alternate Billing Contact Name *		Street Address 2

Street Address *		State/Province *

City*		Telephone*

Zip/Postal Code *		Four Digit Security Pin *

Email *

Acknowledgements

Resp Orgs must certify that the company (including company owners) or the individual requesting to become a Resp Org:

	have not ever been convicted of a crime involving fraud or moral turpitude, including (but not limited to) fraud, blackmail, money laundering, tax evasion, or any other crime of which fraud is an element;

	not be a person or entity determined by the FCC to lack the character or fitness to hold a license or authorization;

	not owe money to satisfy a forfeiture imposed by the FCC or other monetary penalty validly imposed by a governmental entity; or,
	within the past ten years, have not been: (a) convicted of any felony, (b) found by the FCC to have violated one or more of the FCC’s Toll-Free rules (47 C.F.R. § 52.101, et seq.) or orders, (c) found to have violated Section 227 of the Communications Act or the accompanying FCC rules (47 C.F.R. § 64.1200, et. seq.), (d) found to have violated the FTC’s Telemarketing Sales Rule (16 C.F.R. § 310.1, et. seq.); or, (e) subject to an adverse judgment rendered for the wrongful disclosure of proprietary information.

	As a Responsible Organization, I understand that I am bound by the terms and conditions contained in SMS/800 TFN Registry Functions Tariff which is on file with the FCC.