REQUIRED PHONE REGISTRATION - A2P 10DLC

Please fill out all details so that we may complete your A2P

First Name *

Last Name *

Phone *

Email *

Address

Street Address

City

State

Country

Postal Code

Please provide a number that can receive SMS for one-time passwords below.

Legal Business Name *

DBA ( Doing Business As) Name

Business Phone/Cell Phone *

Do you have a domain name you want to use? *

Have you already purchased the domain? *

Is Domain Already Being Used With Website? *

Your Domain name (Website Name) *

URL of Domain Host *

Business Niche *

Authorized Representative Information

Authorized Representative First Name *

Authorized Representative Last Name *

Authorized Representative Email *

Authorized Representative Phone Number *

Select Type of Business *

Position *

Upload CP 575 Form (I.R.S. E.I.N. Confirmation Form) *

Please upload the form, see below for an example

By checking this block and submitting this form, I, the client, hereby authorize DFY CRM to act as my authorized representative in submitting my A2P 10DLC (Application-to-Person 10-Digit Long Code) Registration on my behalf. I acknowledge and agree that my DFY CRM platform subscription and the telephony/SMS usage charges are billed separately. I understand that telephony usage is billed to my messaging wallet, and there is a $10 automatic recharge (auto-top-up) enabled for the wallet, which I can adjust in my phone settings. I acknowledge that the A2P registration process involves an estimated one-time registration fee of approximately $25 and recurring monthly charges to maintain an active campaign and dedicated number with DFY CRM, currently estimated at $3 to $5 per month. Furthermore, I understand that purchasing an additional dedicated phone number may necessitate a change in my campaign type, which could trigger new registration fees and new recurring monthly billing for each number. I understand that submitting inaccurate or incomplete information may delay my registration and incur additional retry fees charged by the A2P registry. I also understand that if I do not currently own a domain name, or if my existing domain name is already in use, a new domain name will be purchased on my behalf at an estimated cost of $17 per year. Finally, I acknowledge that all rates and fees quoted herein are estimated and are subject to change at any time without prior notice, and I agree to contact [email protected] for all definitive billing questions.

Payment Authorization Signature *

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