United States

For Company name, legal name of your company. The value must be 1 to 100 characters.

For Company identification number, legal identification number of your company (such as EIN or VAT). The value must be 1 to 30 characters.

For DBA (Doing Business As) name (optional), dBA (Doing Business As) or brand name if different from the legal name of your company. The value must be 1 to 100 characters.

For Company website, full URL of your company's website. The value must be 4 to 100 characters.

For Legal entity type, legal form of organization.

For Stock symbol (optional), if you are a public profit company it is required to provide the stock market symbol. The value must be 1 to 10 characters.

For Stock exchange (optional), if you are a public profit company it is required to provide the stock exchange on which it's listed.

For Company overview, provide a short description of the products/services your company provides to its customers (i.e. who are you and what do you do?). The value must be 1 to 500 characters.

For Are you an ISV or company managing this short code on behalf of another company ("end-company")? (optional), select "Yes" if you are managing this service on behalf of another company (for example, if you're an ISV). Click the info button for additional information.

For Content provider company name (ISV only) (optional), legal name of content provider company. The value must be 1 to 100 characters.

For Content provider company identification number (ISV only) (optional), legal identification number of the content provider company (such as EIN or VAT). The value must be 1 to 30 characters.

For Content provider company website (ISV only) (optional), full URL of the content provider company's website. The value must be 4 to 100 characters.

For Content provider legal entity type (ISV only) (optional), legal form of content provider.

For Content provider stock symbol (ISV only, if applicable) (optional), if you are a public profit company it is required to provide the stock market symbol. The value must be 1 to 10 characters.

For Content provider stock exchange (ISV only, if applicable) (optional), if you are a public profit company it is required to provide the stock exchange on which it's listed.

For Address 1, physical street address associated with your company. The value must be 1 to 100 characters.

For Address 2 (optional), unit number of the physical address, if applicable. The value must be 1 to 100 characters.

For City, city where the physical address is located. The value must be 1 to 100 characters.

For State / Province (optional), state, province, or region where the physical address is located. The value must be 1 to 50 characters.

For Postal code (optional), postal / ZIP code where the physical address is located. The value must be 1 to 20 characters.

For Country code, two-digit ISO country code where the physical address is located. The value must be 2 to 2 characters.

For Content provider address 1 (ISV only) (optional), physical street address associated with the content provider company. The value must be 1 to 100 characters.

For Content provider address 2 (ISV only) (optional), unit number of the physical address, if applicable. The value must be 1 to 100 characters.

For Content provider city (ISV only) (optional), city where the physical address is located. The value must be 1 to 100 characters.

For Content provider state / province (ISV only) (optional), state, province, or region where the physical address is located. The value must be 1 to 50 characters.

For Content provider postal code (ISV only) (optional), postal / ZIP code where the physical address is located. The value must be 1 to 20 characters.

For Content provider country code (ISV only) (optional), two-digit ISO country code where the physical address is located. The value must be 2 to 2 characters.

For Contact name, name of your company's point of contact. If you are an ISV, input your end customer's information. The value must be 1 to 100 characters.

For Contact email address, email address of your company's point of contact. If you are an ISV, input your end customer's information. The value must be 5 to 100 characters.

For Contact phone number, phone number of your company's point of contact. If you are an ISV, input your end customer's information. The value must be 3 to 30 characters.

For Content provider name (ISV only) (optional), name of the content provider point of contact. The value must be 1 to 100 characters.

For Content provider email address (ISV only) (optional), email address of the content provider point of contact. The value must be 5 to 100 characters.

For Content provider phone number (ISV only) (optional), phone number of the content provider point of contact. The value must be 3 to 30 characters.

For Customer care URL (optional), full URL of your company's customer support page. The value must be 4 to 100 characters.

For Customer care email address, email address of your company's customer support. The value must be 5 to 100 characters.

For Customer care phone number, phone number of your company's customer support. The value must be 3 to 30 characters.

For Short code option, please specify if you would like a Random or Vanity short code, or if you would like a Random code if your preferred Vanity short code is unavailable.

For Vanity short code number preference 1 (optional), if you are requesting a Vanity short code, please specify the short code requested. Specify up to 3 short codes in the order of preference. The value must be 5 to 6 characters.

For Vanity short code number preference 2 (optional), if you are requesting a Vanity short code, please specify the short code requested. Specify up to 3 short codes in the order of preference. The value must be 5 to 6 characters.

For Vanity short code number preference 3 (optional), if you are requesting a Vanity short code, please specify the short code requested. Specify up to 3 short codes in the order of preference. The value must be 5 to 6 characters.

For Service name, service name to include your company or brand name and can include a short descriptor to define the type of messages you are sending. The value must be 1 to 100 characters.

For Use case category, category of SMS messages which will be sent from this short-code number.

For Use case description, description of your use case for sending SMS messages with this short code. The value must be 1 to 500 characters.

For Sweepstakes or contests, will this short code be used for sending sweepstakes related communication?

For Full URL of sweepstakes or contests rules (optional), if yes, you are required to provide a URL to the rules of the sweepstakes. The value must be 4 to 100 characters.

For Sweepstakes or contests document (optional), if a full URL of the sweepstakes or contest rules is not available, please attach document with the rules.

For Debt collection, will this short code be used for sending debt collection related communication?

For HIPAA eligible use case, is your use case HIPAA eligible?

For Average monthly SMS frequency per user, estimated number of SMS messages that users expect to receive from this short code.

For Monthly SMS volume, estimated number of SMS messages which will be sent from this short code each month.

For Message sample 1, at least one sample of an SMS message which will be sent from this short code is required. The value must be 1 to 306 characters.

For Message sample 2 (optional), you may provide an additional sample of your SMS messaging content, if applicable. The value must be 1 to 306 characters.

For Message sample 3 (optional), you may provide an additional sample of your SMS messaging content, if applicable. The value must be 1 to 306 characters.

For Message sample 4 (optional), you may provide an additional sample of your SMS messaging content, if applicable. The value must be 1 to 306 characters.

For Message sample 5 (optional), you may provide an additional sample of your SMS messaging content, if applicable. The value must be 1 to 306 characters.

For Message sample 6 (optional), you may provide an additional sample of your SMS messaging content, if applicable. The value must be 1 to 306 characters.

For Message sample 7 (optional), you may provide an additional sample of your SMS messaging content, if applicable. The value must be 1 to 306 characters.

For Message sample 8 (optional), you may provide an additional sample of your SMS messaging content, if applicable. The value must be 1 to 306 characters.

For Message sample 9 (optional), you may provide an additional sample of your SMS messaging content, if applicable. The value must be 1 to 306 characters.

For Message sample 10 (optional), you may provide an additional sample of your SMS messaging content, if applicable. The value must be 1 to 306 characters.

For MMS (optional), do you require an MMS-capable short code?

For MMS message sample 1 (optional), if you selected yes, you must provide a sample of your MMS messaging content.

For MMS message sample 2 (optional), you may provide an additional sample of your MMS messaging content, if applicable.

For MMS message sample 3 (optional), you may provide an additional sample of your MMS messaging content, if applicable.

For Terms & Conditions URL, full URL of your company's Terms and Conditions page. The value must be 4 to 100 characters.

For Terms & Conditions file (optional), if your Terms and Conditions are not live, provide the full text version.

For Privacy Policy URL (optional), full URL of your company's Privacy Policy page. The value must be 4 to 100 characters.

For Privacy Policy file (optional), if your Privacy Policy is not live, provide the full text version.

For Opt-in type 1, type of user consent to receive messages from this short code number.

For Opt-in method user experience flow 1, create a step-by-step description of the end user experience when signing up for the service, together with the exact verbiage that is presented. The value must be 1 to 1500 characters.

For Opt-in mock-up 1, attach a mock up showing the call-to-action or opt-in workflow.

For Opt-in type 2 (optional), type of user consent to receive messages from this short code number.

For Opt-in method user experience flow 2 (optional), create a step-by-step description of the end user experience when signing up for the service, together with the exact verbiage that is presented. The value must be 1 to 1500 characters.

For Opt-in mock-up 2 (optional), attach a mock up showing the call-to-action or opt-in workflow.

For Opt-in type 3 (optional), type of user consent to receive messages from this short code number.

For Opt-in method user experience flow 3 (optional), create a step-by-step description of the end user experience when signing up for the service, together with the exact verbiage that is presented. The value must be 1 to 1500 characters.

For Opt-in mock-up 3 (optional), attach a mock up showing the call-to-action or opt-in workflow.

For Double opt-in process, will your service provide a double opt-in experience for end users?

For Double opt-in user experience flow (optional), create a step-by-step description of the end user experience when double opting-in for the service, together with the exact verbiage that is presented. The value must be 1 to 1500 characters.

For HELP response, describe the end user experience when your user sends you an inbound message with the HELP keyword. The value must be 1 to 160 characters.

For STOP response, describe the end user experience when your user sends you STOP. The value must be 1 to 160 characters.

For Opt-in keyword, provide the primary keyword that, when sent to the short code, results in the sender being opted in to the messages. The value must be 1 to 160 characters.

For Opt-in confirmation message, provide the message sent to recipients confirming with them that they've opted in to your service. The value must be 1 to 160 characters.