Business & Compliance Information Form
Business Information:
First Name
*
Last Name
*
Title / Role
Legal Company Name
*
DBA (if applicable)
EIN
*
DBA/LLC/Incorporation documentation
*
State Secretary of State’s listing link
Any public or legal filings
Company Address
*
Business Phone Number
*
Website
Number of Employees
*
Dialer System
Dialing & Compliance Information
Max redial attempt per day per lead
*
Max redial attempt per week per lead
*
Amount of Calls Per Day
*
Quantity of phone numbers
*
Telecommunications Provider
Jornaya or Active Prospect Trusted Form (opt-in consent)
*
Yes
No
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TCPA/DNC Violations in the last 6 months
*
Yes
No
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Do you own your DIDs (telephones)?
*
Yes
No
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List is empty.
Calling Practices (Please check all that apply)
*
Compliance with federal and state outbound calling laws, including TCPA, TSR, DNC, Truth in Caller ID Act
Keeping contact database up to date with permissions to contact by phone
Honoring all 'unsubscribe' requests and maintaining a current 'do not call' list
Scrubbing call lists against the National Do Not Call Registry
Not displaying misleading or inaccurate caller ID information
Making calls in accordance with federal and state regulations
Following restrictions on automated calls (RoboCalls)
Compliance with the Fair Debt Collection Practices Act (if applicable)
Not under active investigation related to calling practices
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