KYC Form | WorldAtlantus

1Company Details

2Registration

3Contacts

4Compliance

5References

6Declaration

Step 01 — Company Details

Company Name *

DBA / Other Trade Name(s) *

Company Telephone Number

Company Website URL

Company Address *

Street Address *

Street Address Line 2

City *

State / Province *

Postal / Zip Code *

Country *

Previous Addresses (Past 5 years) *

Step 02 — Company Registration Details

Entity Type *

State of Incorporation *

Years Incorporated *

Years in Business *

RMD Number *

FCC Registration Number *

FCC Registration Name

FCC 499 Filer ID Number *

Name of Entity W/499 Filer ID

Federal Tax ID Number (FEIN) *

Step 03 — Company Points of Contact

Main Contact

Contact First Name *

Contact Last Name *

Main Contact Phone *

Main Contact Email *

Legal / Compliance Contact

Legal First Name

Legal Last Name

Legal Phone Number

Legal Email

Billing / AP Contact

Billing First Name

Billing Last Name

Billing Phone Number

Billing Email

Step 04 — Compliance

Does your business have any certifications that permit or allow pre-recorded messages to be delivered to your customer base? *

Have you received any Traceback requests from your carriers/suppliers within the last 6 months? *

Do you have a Robocall Mitigation Plan on file with the FCC? *

Do you have a Subscription Account Number for the Do Not Originate (DNO) database? *

Do you have a Subscription Account for the Reassigned Number Database? *

Nature of the Traffic *

Traffic Profile *

Step 05 — Trade References

Reference 1

Company Name

Contact Name

Contact Email

Contact Phone

Contact Skype ID

Reference 2

Company Name

Contact Name

Contact Email

Contact Phone

Contact Skype ID

Reference 3

Company Name

Contact Name

Contact Email

Contact Phone

Contact Skype ID

Step 06 — Declaration & Signature

Customer affirms and certifies that all information and answers to questions herein are complete, true and correct to the best of signatory's knowledge and belief. WorldAtlantus retains the right to deny credit or close the account whenever it deems necessary. It is understood and agreed that an investigative report may be made whereby information is obtained through personal interviews with third parties, such as credit reporting agencies, business associates, financial sources, or others with whom the applicant is acquainted. This investigation is not limited to the references listed in this application. This inquiry may include information as to the applicant's capacity, general credit reputation, business character, and other information we deem necessary to make a sound credit decision.

First Name of the Applicant *

Last Name of the Applicant *

Signature of the Applicant *

Date *

EIN Certificate