KYC Form - Dialzilla

Step 01 - Company Details

Company name*

DBA/Other trade name(s)

Company Telephone Number*

Company Website URL

Company Address* Street Address* Street Address Line 2

City*

State / Province*

Postal / Zip Code

Country*

Previous adresses (Past 5 years)

Step 02 - Company Registration Details

State of incorporation*

Years incorporated*

Years in business*

RMD Number*

FCC Registration Number*

FCC Registration Name

FCC 499 Filer ID Number*

Name of Entity W/499 Filer ID

Federal Tax ID Number (FEIN)

Tax Exempt* YesNo

Step 03 - Company Points of Contact

Contact First Name*

Contact Last Name*

Main Contact Phone Number*

Main Contact Email*

Legal/Compliance First Name

Legal/Compliance Last Name

Legal/Compliance Phone Number

Legal/Compliance Email

Billing/AP First Name

Billing/AP Last Name

Billing/AP Phone Number

Billing/AP Email

Step 04 - Compliance

Does your business have any certifications that permit or allow pre-recorded messages to be delivered to your customer base?* YesNo

Have you received any Traceback requests from your carriers/suppliers within the last 6-months?* YesNo

Do you have a Robocall Mitigation Plan on file with the FCC?* YesNo

Do you have a Subscription Account Number For the Do Not Originate (DNO) database?* YesNo

Do you have a Subscription Account for the Reassigned Number Database?* YesNo

Do you have a Subscription Account Number (SAN) for accessing the National Do Not Call Registry?* YesNo

Nature of the traffic*

Traffic Profile*

Step 05 - Trade references

1. Company name

Contact name

Contact Email

Contact Phone Number

Contact Skype ID

2. Company name

Contact name

Contact Email

Contact Phone Number

Contact Skype ID

3. Company name

Contact name

Contact Email

Contact Phone Number

Contact Skype ID

Step 06 - Declaration and signature

Customer affirms and certifies that all information and answers to questions herein are complete, true and correct to the best of signatory’s knowledge and belief. Dawz Telecom USA retains the right to deny credit or close the account whenever it deems necessary. It is understood and agreed that an investigative report may be made whereby information is obtained through personal interviews with third parties, such as credit reporting agencies, business associates, financial sources, or others with whom the applicant is acquainted. This investigation is not limited to the references listed in this application. This inquiry may include information as to the applicant's capacity, general credit reputation, business character, and other information we deem necessary to make a sound credit decision.

First Name of the Applicant*

Last Name of the Applicant*

Signature of the Applicant*

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