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Loyalty Forge – Letter of Authorization

New/Gaining Resporg: BKS01

Billing Telephone Number(s) (Include Area Code) and all related numbers at those locations.

I certify that I am at least 18 years of age, I am the customer or I am authorized by the customer to order service(s) for the number(s) listed on this from.
I am authorizing 1000014258 ONTARIO INC. o/a Loyalty Forge to act as my agent to obtain Customer Service Records/Customer Service Information for all services associated with the numbers listed on this form.
I understand that only one local phone company, one regional carrier, and one long distance carrier can be designated for each telephone number.
This Letter of Authorization shall continue for a period of 90 days from the date signed below.

April 17, 2024

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September 12, 2022 3:41 pm EDT

Loyalty Forge – Letter of Authorization Uploaded by Daniel Brosemer - dan@loyaltyforge.com IP 104.246.170.195