To create an upload authorization, please enter your client number,
your name, and agree to the terms and conditions.
By signing your name above and marking the "I agree" box below you warrant and agree
that the text messages that you are requesting to be sent are being sent to mobile phone numbers
that you or the company that you represent have prior consent to send messages to via automated
dialer and message systems. Furthermore you warrant that you have policies and procedures in
place to allow an insured the option to withdraw permission to receive messages via automated
dialer and/or message systems. You agree to hold harmless MedMessage as stated in the agreement
signed by your organization. You further warrant that you have the authority of the organization
that you represent to enter into this agreement.
I understand that my file will be processed upon upload, and that text messages and/or
certified or priority mail will be sent as a result.
Please check the box to indicate that you agree to the above terms and conditions: