10DLC Messaging Registration Form

Fireline Communications 10 DLC Registration Form (#15)

Contact

Fireline Communications Account Number

Fireline Communications Account Name

Do you already have a registered brand?

Yes

Registered Brand Name

Would you like to Register a Campaign

Yes

Associated Brand

Legal Company Name

Phone Number

Tax Number / ID / EIN

City

Zip / Postal Code

Vertical Type

Organizational Type

DBA or Brand Name

Business Contact Email

Address

State

Country

Website

Campaign Registration

Campaign Type

Standard Campaign

Special Campaign

Standard Campaign

Special Campaign

Campaign Details

Vertical Type

Campaign Description

Automatically Renew Campaign

Yes

Message Flow

Sample Messages

Sample Message 1

Sample Message 2

Sample Message 3

Sample Message 4

Sample Message 5

Campaign Attributes

Are you collecting and processing consumer opt-in?

Yes

Subscriber opt-in keywords

Subscriber opt-in message

Are you collecting and processing consumer opt-out?

Yes

Subscriber opt-out keywords

Subscriber opt-out message

Have you implemented a response to the HELP keyword informing customers of how they can contact the message sender?

Yes

Subscriber help keywords

Subscriber help message

Will more than 50 TNs be used for this campaign?

Yes

Will the campaign include content related to direct lending or other loan arrangements?

Yes

Are you using any embedded phone number beyond the contact number in the HELP response?

Yes

Will the campaign include any age-gated content as defined by carrier and CTIA guidelines?

Yes

Terms & Conditions 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.