LOAs / LOA-2291 / Signed

Letter of Authorization

Pinecrest Dental Group · PR-10479 · Losing carrier AT&T · 12 numbers across 4 sites

Resend for signature

Authorizing party

CSR verified

Must match the losing carrier's CSR exactly.

Legal business name
Pinecrest Dental Partners PLLC
Account number with AT&T
287-441-9920
Billing telephone number
828-555-7731
Account PIN · requested from customer
Not supplied
Service address
1204 Greenville Hwy, Hendersonville, NC, 28792

Numbers to port

12 of 12 included
SiteRangeCountType
Asheville South 828-555-0480 to 04823 Local DID
Brevard 828-555-2210 to 22112 Local DID
Hendersonville (main) 828-555-7731 to 77366 Local DID
Toll-free 800-555-01991 Toll-free (RespOrg)

Signing order

2 of 2 signed
✓
Priya Natarajan Practice Administrator · priya@pinecrestdental.example
Signed OCT 09, 01:34
✓
Dr. Alan Reyes Managing Partner · areyes@pinecrestdental.example
Signed OCT 09, 01:35

Submit checklist

✓ Legal name matches CSR
✓ Account number
✓ Billing telephone number
✓ CSR verified
Account PIN
✓ Desired port date
✓ All signers complete

Activity

Signed by Dr. Alan ReyesOCT 09, 01:35 · drawn · IP 198.51.100.24
Document sealedOCT 09, 01:35 · SHA-256
Opened by Dr. Alan ReyesOCT 09, 01:34 · IP 198.51.100.24
Signed by Priya NatarajanOCT 09, 01:34 · drawn · IP 198.51.100.24
Opened by Priya NatarajanOCT 07, 16:12 · IP 203.0.113.77
Sent to Priya NatarajanOCT 05, 11:05 · email · reminder every 2 days
LOA created by Jordan MillsOCT 05, 11:02 · 12 numbers across 4 sites