Letter of Authorization

For Local Number Porting (LNP)

The undersigned hereby authorizes MCN to act on the Customer’s behalf to port the numbers listed below.

Current Provider *

Please fill out the following information as it appears on the Customer Service Record (CSR) of the current carrier:

Customer Name *

Customer Address *

City *

State *

Zip *

Please fill out the following information as it appears on the customer invoice with the current carrier:

Billing Address *

City *

State *

Zip *

Additional Portability Information

What is your existing BTN (Billing Telephone Number) with current carrier? * This is the primary phone number on your bill with your current carrier. If you don't know what it is use your phone number.

Will you be porting this BTN? * Are you porting this number to MCN, or no if this numbers stays with your existing carrier.

If yes, please indicate a new BTN for your current carrier? If you are porting the main number and leaving numbers behind you can specifiy a new primary BTN.

Is this a partial port? * A partial port means you are only porting some of the numbers on your account. If you are porting all your numbers or you only have one select no.

Questions/Special Instructions If you have questions or there is any special instructions we should know about your line, please put them here.

Signature *

Sign with the mouse or your finger if you are are on a touch screen.

Date

Are you a human? *

Sometimes we get bots that try to post to our form. It's a hassle for you and so we have to know if you are a human or a computer. If you are a bot, please select computer. Otherwise, let us know you are a real person.