10DLC Messaging Registration FormPrint PDFPrint ClassicFireline Communications 10 DLC Registration Form (#15) Newsletter Fireline Communications Account NumberFireline Communications Account NameDo you already have a registered brand? Yes NoRegistered Brand NameWould you like to Register a Campaign Yes NoAssociated BrandLegal Company NamePhone NumberEmailTax Number / ID / EINCityZip / Postal CodeVertical Type- Select -Real EstateHealthcareEnergyEntertainmentAgriculturalInsuranceEducationHospitalityFinancialGamblingContructionNGOManufacturingGovernmentTechnologyCommunicationOrganizational Type- Select -Privately Held OrganizationPublicly Traded OrganizationNonprofit OrganizationGovernmentDBA or Brand NameBusiness Contact EmailAddressStateCountry- Select -United States of AmericaCanadaWebsiteCampaign RegistrationCampaign Type Standard Campaign Special CampaignStandard Campaign- Select -2FACustomer CareDelivery NotificationFraud Alert MessagingHigher EducationLow Volume MixedPolling and VotingPublic Service AnnouncementsSecurity AlertSpecial Campaign- Select -Agents FranchisesCarrier ExemptCharityEmergencyPoliticalProxySocailSweepstakeK-12 EducationCampaign DetailsVertical Type- Select -Real EstateHealthcareEnergyEntertainmentAgriculturalInsuranceEducationHospitalityFinancialGamblingContructionNGOManufacturingGovernmentTechnologyCommunicationCampaign DescriptionCampaign DescriptionAutomatically Renew Campaign Yes NoMessage FlowSample MessagesSample Message 1Sample Message 2Sample Message 3Sample Message 4Sample Message 5Campaign AttributesAre you collecting and processing consumer opt-in? Yes NoSubscriber opt-in keywordsSubscriber opt-in messageAre you collecting and processing consumer opt-out? Yes NoSubscriber opt-out keywordsSubscriber opt-out messageHave you implemented a response to the HELP keyword informing customers of how they can contact the message sender? Yes NoSubscriber help keywordsSubscriber help messageWill more than 50 TNs be used for this campaign? Yes NoWill the campaign include content related to direct lending or other loan arrangements? Yes NoAre you using any embedded phone number beyond the contact number in the HELP response? Yes NoWill the campaign include any age-gated content as defined by carrier and CTIA guidelines? Yes NoTerms & Conditions URLPrivacy Policy URL By signing this form, I hereby attest that all information provided is true and accurate to the best of my knowledge. I understand and agree to abide by the laws and regulations governing SMS messaging in the United States. I acknowledge that Fireline Communications is not responsible for any inaccuracies in this form.Submit Form Last Updated on July 8, 2025
