Letter of Authorization

I, hereby select Mobex to be my local exchange provider and to act as our Agent in dealings with our current local exchange telephone company. Mobex may place orders for new services and changes to existing services. This authorization covers the following locations and telephone numbers and shall remain in effect until further written notice is provided. I understand that I can have only one local service provider for any one telephone number.

Company Name:

Company Billing Address (As it appears on your current bill):

Company Physical Address (If different):

Main Billing Telephone Number on Account:

PIN on Account (If applicable):

Name of authorized person to act for company
(As listed with your current carrier):

Telephone number of authorized person to act for company:

Email address of authorized person to act for company:

Please list all telephone numbers you wish moved to Mobex (separate them with commas):

Authorized Signature:

I certify that I have read and understand the Letter of Authorization. I further certify that I am at least eighteen years of age, and that I am authorized to change telephone numbers listed here. I authorize Mobex to provide service to all of my telephone number(s) that I have listed on this form.

Printed Name:

Title:

Date:

Pay By Credit Card

Name on Credit Card:

Credit Card Number:

Expiration Date:

CVV # :

Pay By Bank Account (USA Only)

Bank Name:

ABA Routing Number:

Account Number:

Bank Account Type (Business Checking, Personal Checking, Personal Savings):

Name on Bank Account:

Billing email address:

Address to send paper invoice:

Tax Id Number:

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Letter of Authorization

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Join Mobex and
work without limits.