10DLC Registration Form — Business Texting Brand & Campaign

1

Your information

We’ll reply to this email address with any questions about your registration.

First name*

Last name*

Email*

Phone

Company legal name*

Exactly as it appears on your IRS/EIN documents.

Do you need a new Brand registration?*

2

Campaign: what will you text?

Tell us the purpose of your messages. Most small businesses choose Low Volume Mixed.

Direct lending or loan arrangements?*

Phone numbers in your messages?*

Age-gated content?*

Links (URLs) in your messages?*

Attestations*

I confirm this campaign will not be used for affiliate marketing, and phone numbers or consent will not be sold or shared with third parties.

I confirm we will collect opt-in consent, honor opt-out requests (STOP), and respond to HELP requests.

Campaign description*

Who is sending, who receives the texts, and why. Example: “ABC Dental sends appointment reminders and billing notices to patients who opted in at check-in.”

Sample messages

Sample message 1*

Include your business name and opt-out language, e.g. “ABC Dental: Reminder of your cleaning on 5/12 at 2pm. Reply STOP to opt out.”

Sample message 2*

Sample message 3 (optional)

3

How customers opt in

Carriers require proof that recipients agreed to receive your texts. Check every method you use.

Implied opt-inThe customer texts you first (e.g. asks a question by text).

Paper or digital form Consent checkbox/signature on an intake, registration, or sign-up form.

Verbal opt-in Customer agrees by phone or in person and you record it.

Text a keyword Customer texts a keyword (like START) to your number.

Website form A web form with an SMS consent checkbox.

Screenshots or copies of your opt-in (optional)

Images or PDFs, up to 5 files, 10 MB each. Photos of signage or a blank sign-up form work great.

4

HELP contact & phone numbers

How customers reach you when they reply HELP, and which numbers will send texts.

HELP reply contact info*

Email

Phone

Website

Phone numbers to enable for texting*

One per line (or comma-separated). 10-digit US/Canada numbers, up to 49.

Anything else we should know? (optional)

5

Sign & submit

No formal signature needed — just type your full name.

Type your full name*

Date:

I certify that the information above is accurate, that I’m authorized to submit it on behalf of this business, and that our messaging will follow carrier and CTIA guidelines.

Your answers are saved on this device as you type, so you can finish later. After submitting you can download a PDF copy.