The undersigned Toll Free number holder does hereby appoint Grand Canyon Business Solutions as the Responsible Organization for toll free numbers.
Please do not include Standard DIDs that need to be ported on this form - they each have a separate porting form.
* = Required
Please enter the account owner's first and last name here.
Please enter the account owner's email address here.
Please enter your company name.
This is the day you would like the Toll Free phone number(s) fully ported over to AZ Health Systems. This port date is not guaranteed and we will send a confirmation on the port date once received. Please leave this field blank if you would like GCBS to schedule this porting date.
MM slash DD slash YYYY
Please enter all of the Toll Free phone numbers that you would like ported over to AZ Health Systems. The + icon to the right of the blank space will create an extra phone number entry line.
Additional Porting Information
Please enter the account owner's title here.
This is the primary phone number located on your last phone bill.
This is the primary fax number located on your last phone bill if applicable.
Please enter the account number for the previous telecom service provider. (This information can usually be found on the most recent phone bill/invoice.)
This information is only used if it's required by your current/old telephone service provider for phone number porting.
The most recent phone bill is required for successful porting.
Accepted file types: jpg, gif, png, pdf, Max. file size: 2 GB.
Drop files here or
Do not cancel service with your current phone service provider until you receive notice that your toll free number has been successfully ported and is active on GCBS.
This is the new RespOrg your toll free numbers will be ported into:
New RespOrg: AUC72
New RespOrg Contact: Eastern Rep
New RespOrg Telephone Number: (541) 593-2900
New RespOrg Fax Number: (541) 593-2090
Please enter any additional questions or comments here.