HawkSoft Contract ID: *

Your Name: *

Your Email: *

Your Job Title: *

Legal Company Name: *

DBA or Brand Name, if different from legal name:

Country of Registration: *

Type of Organization: *

Employer Identification Number (EIN): *

EIN Issuing Country:

DUNS or GIIN or LEI number (type):

DUNS or GIIN or LEI number (value):

Address: *

City: *

State: *

Zip: *

Stock Symbol:

Stock Exchange:

Vertical Type: *

Does your agency have a website? *

Yes

Does your agency plan to send your office or other phone number(s) in text messages?
(Ex: Please call us at 123-456-7890 so we can discuss your policy.)

Yes

Does your agency plan to send website links in text messages?
(Ex: Please visit www.youragency.com for more information.)

Yes

Do you wish to enroll in Main Number Texting? *
(Allows you to set up your main office phone number to send and receive texts. You will incur a $99 one-time setup fee on your next HawkSoft invoice. There is no monthly fee for this feature.)

Yes

The Campaign Registry, the entity enforcing the new text messaging rules, requires your agency to provide a sample text message of what you will be sending to your clients. We will submit the following sample text message on your agency's behalf. Your agency can submit text messages with other content as well, but HawkSoft is required to provide at least one sample message when registering your agency.

Hello, this is AGENCY NAME, and we are your insurance agent. Please contact us to discuss your policy.

By submitting this form, you certify that you are authorized to make decisions on behalf of the entity named in the Legal Company Name field above, and that you acknowledge the HawkSoft Text Messaging Terms & Conditions.

HawkSoft 10DLC Data Collection Form