Loyalty Forge

Loyalty Forge – Letter of Authorization

New/Gaining Resporg: BKS01

Contact Phone
Title Email
City Province Postal Code


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

  1. 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.
  2. 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.
  3. I understand that only one local phone company, one regional carrier, and one long distance carrier can be designated for each telephone number.
  4. This Letter of Authorization shall continue for a period of 90 days from the date signed below.

September 25, 2023

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Signature Certificate
Document name: Loyalty Forge – Letter of Authorization
lock iconUnique Document ID: 388df73d77ba8b6dbb20a000702ec860b1fe1352
Timestamp Audit
September 12, 2022 3:41 pm EDTLoyalty Forge – Letter of Authorization Uploaded by Daniel Brosemer - dan@loyaltyforge.com IP