10DLC/A2P SMS Text Messaging Brand & Campaign Registration Form This form can be used for first-time Brand and Campaign registrations or for additional Campaign registrations to an existing company’s Brand. You can only register one campaign per form submission. If you already have a Brand ID for your company please proceed to Part II of this form.Part I: Brand Information & DetailsBy completing the form below, you are verifying the information is accurate and true. The information provided will be submitted to the "The Campaign Registry" (TCR) an Independent Reputation Authority chosen by Mobile Network Operators (MNOs) to collect Brand and Campaign data in order to allow for transparency on the 10DLC network.Legal Company Name(Required)The company or entity sending & receiving SMS/MMS messages. DBA or Brand Name (If different from legal name) Country of Registration(Required) United States Canada Type of Organization(Required) Publicly Traded Company Private Company (Inc., LLC, Corp.) Charity/Non-profit Government Tax Number/ID/EIN(Required)State or Government Registered ID# Legal Business Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Website(Required) Industry/Vertical Type(Required)Select the best vertical type that fits your business. Agriculture Media and Communications Construction, Materials, & Trade Services Education Energy and Utilities Entertainment Financial Services Gambling & Lottery Government Services & Agencies Healthcare & Life Sciences Hospitality & Travel HR, Staffing & Recruitment Insurance Legal Manufacturing Non-Profit Organization Political Postal & Delivery Professional Services Real Estate Retail & Consumer Products Information Technology Services Transportation & Logistics Contact Name(Required) First Last Contact Phone Number(Required)Contact Email(Required) HiddenEmail(Required) Contact Address (If different from Company) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Part II: Declare your Single Use Case for the campaign that you are registering for in this form.Most companies can be served by 'Low Volume Mixed' use case, which includes less than 2,000 messages per day or 75 Texts Per Minute. (Standard Use Cases are immediately available for all qualified registered Brands and do not require Vetting or pre/post-approval by MNOs. Special Use Cases are sensitive or critical in nature and may require Vetting or pre/post-registration approval by MNOs. During the review process you may begin to send messages).Existing Brand ID (per applicable)Please include your existing 10DLC BRAND ID with The Campaign Registry (TCR) ONLY IF you have previously registered your SMS-enabled number with a different carrier. Use Case (Select One)(Required)The indicated "Use Case" will help the MNOs determine the type of "Campaign" your messaging will fall under. LOW VOLUME MIX- less than 2,000 messages per day or 75 texts per minute. TWO FACTOR AUTHORIZATION- any authentication, verification, or a one-time passcode. ACCOUNT NOTIFICATIONS- Standard notifications for account holders, relating to and being about an account. CUSTOMER CARE- includes account management and customer support. DELIVERY NOTIFICATIONS- status of delivery for products or services FRAUD ALERT MESSAGING- messaging regarding potential fraudulent activity on an account. HIGHER EDUCATION- campaigns created on behalf of colleges/universities. Includes school districts and educational institutions that fall outside of any "free to the consumer" messaging model. MARKETING- marketing/promotional content MIXED- any undeclared combination of use-cases. POLLING & VOTING- requests for surveys and non-political messages. PUBLIC SERVICE ANNOUNCEMENT- An informational message that is meant to raise the audience's awareness about an important issue. SECURITY ALERT- a notification that the security of a system, either a software or hardware, has been compromised in some way and there is an action you need to take. [SPECIAL USE CASE] CARRIER EXEMPTIONS- exemption by Carrier. [SPECIAL USE CASE] CHARITY- communications from a registered charity aimed at providing help and raising money for those in need. 5013C Charity included. Religious organizations are not included. [SPECIAL USE CASE] CONVERSATIONAL MESSAGING- Peer-to-peer app-based group messaging with proxy/pooled number for enterprise or A2P communications. [SPECIAL USE CASE] EMERENCY- notifications that are designed to support public health /safety during natural disasters, armed conflicts, & other national or regional emergencies. [SPECIAL USE CASE] SWEEPSTAKES [SPECIAL USE CASE] POLITICAL- part of an organized effort to influence the decision-making of a specific group. Only available to 501(c)(4) and 527 Organizations. [SPECIAL USE CASE] SOCIAL- communications within or between closed communities (ex- Influencer's alerts). [SPECIAL USE CASE] SOLE PROPRIETOR- limited to entities without an EIN/TAX ID. [SPECIAL USE CASE] AGENTS & FRANCHISE AGENTS, FRANCHISES, LOCAL BRANCHES- Post-registration approval by MNO is required for this Use Case. Mix Use CasesThe following section applies to "Low Volume Mix," "Mix" or "Conversational Messaging" use cases. Per applicable, you may choose up to five (5) sub-categories associated to your Mix Use Case selection above. Two Factor Authentication Customer Care Fraud Alert Messaging Marketing Public Service Announcement Account Notification Delivery Notification Higher Education Polling and Voting Part III: Campaign & Content AttributesCampaign and Content Attributes are characteristics of the Campaign in which you are registering for. Please complete the following questionnaire below. Number Pooling(Required)Select "yes" to number pooling if you intend to use 50+ numbers under one campaign. Please note, selecting "yes" will require a different provisioning process with certain wireless carriers. Yes No Direct Lending or Loan Arrangement(Required)Indicates whether the campaign include content related to direct lending or other loan arrangements. Yes No Embedded Link(Required)Indicates whether the campaign is using an embedded URL link of any kind. Note that public URL shorteners (bitly, tinyurl) are not accepted. Yes No Embedded Phone Number(Required)Indicates whether the campaign is using an embedded phone number (except the required HELP information contact phone number). Yes No Affiliate Marketing(Required)Indicates whether the affiliate marketing being used or was used in the construction of the campaign. Yes No Age-gated/SHAFT-C Content(Required)Indicates whether the campaign include any age-gated content as defined by Carrier and CTIA guidelines (Content requiring the individual to be of legal age). NOTE: The following types of content are prohibited on 10DLC: Hate, Alcohol, Sex, Firearms, and Tobacco (cannabis, CBD, etc.). It’s also not allowed to be on the customer's website at all. Example: If a chiropractor's office has CBD oils on their website, the campaign will be denied even if not directly related to CBD marketing. Yes No Campaign Description(Required)Please explain your campaign objective or purpose IN DETAIL. In other words, how will your business use text messaging to communicate with clients, vendors, prospects, etc.Campaign Sample Message(Required)Please include TWO campaign sample messages. Please ensure that you include an opt-out word (STOP, END, UNSUBSCRIBE) in at least one of your messages. Example of first message: "Thank you for contacting [Company Name ]. You have been successfully opted in to receive SMS text messages. To opt-out, or unsubscribe, please reply STOP at any time. If you require further assistance, please reply HELP and a member of our team will contact you shortly." Call to Action(Required)This section should contain a clear and concise description of how an end user signs up to receive messages. Opt-in must be 1 to 1, can't be shared with third parties, and can't be implied. It must be clear, conspicuous, and can't be obscured within the terms & conditions and/or other agreement(s). EXAMPLE: "Consumers can opt-in to [Business Name] messaging services by texting START to [phone number]. To opt-out, text STOP at any time. For further assistance, text HELP." NOTE: If opt-in will be collected via website, then the URL of the opt-in form or button must be included or your campaign will be rejected. Please list the phone numbers associated with this campaign.(Required)Please list ALL phone numbers that will utilize SMS text messaging service to send and receive text messages (up to 49 numbers allowed per campaign). Phone numbers should be typed with ten digits only with one number per row. No spaces, parenthesis, or commas. Toll-free numbers do not qualify for 10DLC. To register your SMS-enabled TOLL-FREE numbers, please use this form: https://www.acctelecom.com/toll-free-messaging-compliancy-form/.Opt-in, Opt-out, Help(Required)The associated Brand entity agrees to include and support the following campaign content attributes. MUST SELECT ALL TO REMAIN COMPLAINT. SUBSCRIBER OPT-IN - You are informing clients how to opt-in to your messages, and collecting and processing consumer opt-ins. SUBSCRIBER OPT-OUT - You are informing clients how to opt-out of your message service, and collecting and processing consumer opt-outs. SUBSCRIBER HELP - You have implemented a message reply providing customers on how they can contact the message sender after they reply with the “HELP” keyword. Select AllName of Person Submitting Form (if different from company contact) First Last Date MM slash DD slash YYYY Consent(Required) I agree that the above information is accurate and true, and the registered Brand, of whom I am an authorized Contact for, agree to remain complaint by not sending SMS/MMS messages that constituent as "spam” by following the recommended guidelines set forth in this form and with the Mobile Network Operators (MNOs). I understand violation of these guidelines may result in permanent removal of my Brand and Campaigns from The Campaign Registry (TCR) and associated fines. Upon submission of this form, I acknowledge and agree to pay a one-time Brand registration fee and a monthly fee for each campaign that is registered under the Brand.CommentsThis field is for validation purposes and should be left unchanged. Δ