Prerequisites:

Please do not submit the form to [email protected] without the prerequisites being completed

1) The company website submitted above must match the company name

Ex: ACME Corp and www.acme.com

2) The website must have HTTPS (SSL)

Site with no SSL will look like the below on your browser

3) The website must have a disclaimer and the disclaimer must have wording like the following:
“Any personal information that we collect (as identified in the “Personal Data We Collect” section) will not be shared with third parties.”

4) If your website has a form (even if it’s not used for messaging) you must have a disclaimer beneath the form similar to the following:

Legal Company Name: *

DBA or Brand Name (if different from legal name):

Country of Registration: *

What type of legal form is the organization? (Individual, publicly traded Company, Private Company, Charity/non-Profit Organization) *

Tax Number/ID/EIN: *

Address *

City *

State *

Postal code *

Website *

Vertical Type: *

Contact Details

Full Name *

Phone *

Email *

Campaign Information

Use Case (select one of the below)

Special Types

Campaign Content and Attributes

NOTE: The below fields are mandatory for any message campaign. The campaign will not receive approval with out them being filled out with as much detail as possible

Campaign Description *

Call-to-Action / Message Flow: *

Sample_Messages *

Opt-in message *

Opt-out message *

help message *

Other (Please specify):

Example verbiage

Campaign Description:
Please be very specific and include as much detail as possible.

Example: This is a doctor’s office and patients receive appointment reminders and updates

Call-to-Action / Message Flow:
Provide a detailed description of how the customer’s opt-in and provide a screen shot from your website

Example: Customer’s sign up to receive messages via our website. Attached is a screen shot

Sample Messages
Sample message should include wording similar to, please respond with stop to stop receiving future messages

Example: This is [Company Name]. Your appointment is at 5pm EST. Please respond with stop to stop receiving future messages.

Opt-in message
Example: Welcome to [Company Name] thank you for signing up. We will receive messages from us for alerts, updates or appointments. Msg&data rates may apply. Reply STOP to cancel.

Opt-out message
Example: You've opted out of [Company Name]. updates. No more msgs will be sent. Reply HELP for assistance.) :Click to edit

help message
Example: For assistance with [Company Name]. updates, email [your email] or call [your number]. Reply STOP to cancel updates. : Click to edit

I Consent to Receive SMS Notifications, Alerts & Occasional Marketing Communication from company. Message frequency varies. Message & data rates may apply. Text HELP to (877) 308-5803 for assistance. You can reply STOP to unsubscribe at any time.