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Letter of Agency – Authorization to Access
Telephone Provider Records
By signing this letter below, I am giving authorization to The SpyGlass
Group, LLC and its affiliates (a) to access any and all customer service
records, account information, contracts, long distance carrier information,
pending order activity and/or any other information relevant to my local or
long distance telecommunications service (voice or data), and (b) to
establish electronic or online access to any billing for such service, if not
already established, or if already established, to be provided login
information for such electronic or online access. At SpyGlass’ request, I
give authorization to Provider to transmit customer service records and any
requested documentation via email, fax to 440-348-9355 or mail to The
SpyGlass Group, LLC, 25777 Detroit Rd., Ste. 400, Westlake, Ohio 44145.
I represent that I have the authority to execute this form and grant this
permission and I hereby desire for SpyGlass to be added as an authorized
point of contact (POC) for these accounts. This permission shall remain in
effect until I affirmatively revoke it. If I withdraw the authorization set forth
in this Letter, I will notify Provider immediately in writing.
Client Information:
Signing Employee’s Name: _____________________________
Company Name: _____________________________
Address: _____________________________
City, State, Zip Code: _____________________________
Telephone: _____________________________
Provider Information:
Provider Name: _______________________________
Account Number (s):
Authorized Signature: ______________________________
Date: ________________________
DocuSign Envelope ID: 09E4911E-E221-4154-A00F-520761A2B772
City of Bremerton
(360) 473-5303 Office
Bremerton, WA 98337
Mike Riley
4/26/2021
345 6th Street, ste 100