Letter of Agency

"*" indicates required fields

My signature below certifies that I am the customer of record or the authorized representative for payment for each of the telephone numbers listed below.

For each of the telephone numbers listed herein and on Attachment A, I appoint Flux Labs, Inc. (hereinafter “Flux Labs”) to act as my Agent for the purpose of collecting my account information with my current local telephone carrier or provider (hereinafter “Provider”).

By selecting Flux Labs to act as my Agent to research my current services with my current Provider of local telephone service, I am authorizing the change of my local telephone Provider from that/those which I am currently using to Clarity. This authorization will expire with written notification only.

Primary Phone Number*

Current Provider*

Account Number*

Company Name (Must match bill)*

Street Address*

City, State, Zip*

Account Contact*

Active person on the account who can make changes.

Account Contact E-mail*

Account Title with Company*

Account Contact Telephone Number*

Not primary phone number

Phone Numbers to be Ported

Please list all numbers you need ported from this provider. Enter 1 per line

Please attach your latest phone carrier bill*

Drop files here or

Max. file size: 20 MB.

Signature*