CompuTxt : Sign Up

Thank you for choosing Computxt as your SMS service provider. In order to transition the service to Computxt, this form must be completed as proof that you are explicitly authorizing and request that your SMS service be transferred to Computxt as your new SMS service provider. By filling in all the information requested below, checking the box, signing and dating this letter, you are providing us with the authorization to initiate the process of transferring SMS to Computxt. Computxt is a wholly owned property of Compu-Phone Voice & Data, Inc.

Please Check the Box Below

I select Computxt as the service provider for SMS/MMS Only, and wish to leave my voice services as they are today. Computxt will only support messaging to and from this number.

Please complete the information below as it appears on your Provider's bill.

Name* (as it appears on your bill)

Current Provider Name

Street Address* (as it appears on your bill)

City*, State*, Zip*

Main Telephone Number*

List of Phone Numbers to Enable for SMS

Specify a telephone number range

Beginning of Range

End of Range

Payment Information

Card Type

Visa

Mastercard

American Express

Credit Card Number*

Expiration Date*

Name on Card*

CVV*

By signing below, I designate Computxt to transfer SMS service from my current telephone provider for the above listed telephone numbers to Computxt By signing below, I also authorize Computxt to obtain billing information, customer service records, and other information that may be required to provide me with service on the Computxt network and initiate billing to the credit card I have provided. I have read the Computxt Terms of Use located at www.computxt.com/terms.

Print Name:*

Date:*

Signature:*