Medsender- Fax Number Port: Letter of Authorization (LOA)
A Letter of Authorization (LOA) must be completed by the end-user and supplied to Medsender, Inc. upon request. The LOA must contain the name and current service address of the end-user and the numbers that will be ported to Medsender, Inc. from the end-user’s current carrier. The LOA used must comply with FCC regulations and must be dated and signed by the end-user or a person who has the authority to act as a legal agent.

Dear Medsender Customer,
Thank you for choosing Medsender, Inc. as your service provider. As you are aware, you may continue to use your existing fax number with Medsender, Inc. In order to transition your current telephone number to Medsender, Inc., Medsender, Inc. must work with your previous service provider to ensure that your service is uninterrupted, and where applicable, to ensure that your number is transferred.


PLEASE DO NOT PLACE ANY NEW SERVICE ORDERS OR DISCONNECTS WITH YOUR CURRENT SERVICE PROVIDER ON THIS ACCOUNT, AS THIS WILL CAUSE A DELAY IN PORTING YOUR NUMBERS.

Please complete the form below to begin the porting process.
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Email *
Fax Number(s) to port *
Enter your fax number(s) below. Separate multiple numbers with commas as needed.
Contact number *
Account Name *
In case we need to contact you for more information
Do you have a copy of your phone bill?
If yes, you can email a copy of it to support+porting@medsender.com. While optional, this can help to significantly expedite the porting process.
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Name of Business *
Billing Phone Number *
Service Address *
Include your full address, City, State, and Zip code
Name of Partner / Reseller (Optional)
If you are signing up for Medsender through a third party company, such as your EMR vendor, please provide their name below. If you are signing up directly through Medsender, you can leave this field blank.  
Electronic Signature *
Please type your full legal name
Date of Signature *
MM
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DD
/
YYYY
I hereby certify that the above information is correct, and that I have legal authorization to port this number. By checking the box below I designate Medsender, Inc. or its designated agent to transfer my service from my current provider to Medsender, Inc. By checking the box below I also authorize Medsender, Inc. or its designated agent to transfer my current telephone number used to provide service so that Medsender, Inc. may provide its service to me. By signing below, I also authorize Medsender, Inc. or its designated agent to obtain billing information, customer service records and other network information required to provide me with Medsender service. *
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A copy of your responses will be emailed to the address you provided.
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