The Tennessee Ps 0376 form is a Solicitor Registration Application used to gain access to the Tennessee “Do-Not-Call Register.” This form is essential for businesses and individuals who wish to ensure compliance with state regulations regarding telephone solicitations. To get started on your application, fill out the form by clicking the button below.
The Tennessee Ps 0376 form serves as a critical tool for businesses seeking to engage in telephone solicitation while adhering to state regulations. This application allows solicitors to gain access to the Tennessee “Do-Not-Call Register,” ensuring compliance with the Tennessee Regulatory Authority's rules. The form requires detailed information about the applicant, including the legal name of the business, nature of the business, and whether the application is for a new registration or a re-registration. Additionally, it prompts applicants to disclose whether they utilize automated dialing systems, along with the contact details of designated representatives responsible for maintaining compliance and addressing any inquiries. Applicants must also provide information about any subsidiaries or affiliated companies that may access the Do-Not-Call Register. The form outlines the associated fees, which vary based on the type of registration, and emphasizes the importance of notifying the Tennessee Regulatory Authority of any changes to the application. Furthermore, the form necessitates a compliance statement affirming adherence to relevant laws and regulations, underscoring the commitment required from solicitors to operate within legal boundaries. Overall, the Tennessee Ps 0376 form is essential for maintaining ethical telemarketing practices and protecting consumer rights in the state.
Tennessee Regulatory Authority
460 James Robertson Parkway
Nashville, TN 37243-0505
Telephone Solicitor Registration Application
Application is hereby made to obtain access to the Tennessee “Do-Not-Call Register” pursuant to TRA Rule 1220-4-11-.04 Registration submitted for July 1, 2012 – June 30, 2013. Please print or type the information requested below.
Federal Taxpayer ID or SS# of Applicant ____________________ Check one: New Registration _____ Re-registering_____
Name of Your Company
__________________________________________________________________________________________________
Legal name of corporation, partnership, or proprietorship for which application is made.
________________________________________________________________________________________________________________________
Business or individual name used when contacting the public.Trade name(s), assumed name(s) or fictitious names used.
Nature of Business_______________________________________________________________________________________________________
This registration is for: _______ Standard Registration ________Principal Solicitor (mark one with X)
Choose one: Delivery by E-mail of the DNC List: email address________________________ For delivery by CD check here__________
Contact person for inquiries from the TRA. (Mailing address for contact must be within US borders; phone numbers must be US area codes or toll free numbers. This is the only person authorized to make changes to your company information. This person is responsible for keeping all application information on file, correct and updated with the TRA.
Phone #______________________ Fax #___________________ E-mail Address ________________________________
Designated Contact Name
Address
City
State Zip Code
Person authorized to respond to notices of alleged violations from TRA.
Phone #______________________ Fax #____________________ E-mail Address_______________________________
Name of authorized person
Is applicant utilizing ADADs or predictive dialers for calls originating or terminating in Tennessee?
Yes____ No _____
Provide the telephone number(s) for responding to inquiries relative to the telephone solicitation during hours when
telephone solicitations are being made. Toll Free (
)____-__________.
Provide name, address and telephone number of Telemarketer if your telemarketing is being outsourced:
Name of Company Contact Person AddressCity StateTelephone number
Provide the name, address and telephone number of the Registered Agent for Service of Process. (must be located in Tennessee)
Name
Telephone #
email address
PS-0376 (REV 4/10)
On a separate sheet of paper marked as supplemental attachment 2, list the name, address and telephone number of all subsidiaries and affiliate companies associated with your company which will have access to your Do-Not-Call Register. An affiliate company is one that your company effectively controls because of its ownership interest. A subsidiary company is one as to which your company owns more than 50% of the voting shares.
If you are registering as a Principal Solicitor, submit a supplemental attachment 1 with this application.
FEE:
1.If you marked standard registration, mail the completed application (original) along with any attachments thereto including a certified cashier’s check or money order for $500.00 to: Tennessee Regulatory Authority, Attn: DO-NOT-CALL REGISTER, 460 James Robertson Parkway, Nashville TN 37243-0505.
2.If you marked Principal Solicitor, mail the completed application including a certified cashier’s check or money order in the amount of $1,000.00 and an additional $50.00 for each independent solicitor listed on the supplemental attachment 1 to: Tennessee Regulatory Authority, Attn: DO-NOT-CALL REGISTER, 460 James Robertson Parkway, Nashville TN 37243-0505.
Compliance Statement:
The Tennessee “Do-Not-Call Register” telephone solicitor applicant, hereby, affirms the following:
I/We will comply with the Tennessee Regulatory Authority’s (“TRA”) Rules and Regulations Chapter 1220- 4-11 and all other applicable state laws, including but not limited to T.C.A. Section 65-4-401, et seq.
I/We will notify the Tennessee Regulatory Authority within thirty (30) days of any material change relative to this application or the information contained therein.
Having been duly sworn, and under the penalties of perjury, I hereby certify that the representations in the APPLICATION and all attachments are true and correct to the best of my knowledge and belief.
___________________________
SIGNATURE
______________________________________________
_________________________________
NAME OF APPLICANT-COMPANY NAME
PRINTED NAME
TITLE
Subscribed and sworn to or affirmed before me, this __________day of _________________________ , _____________________.
Day
Month
Year
Known to be the person named in, and who executed the foregoing application.
My commission expires on ________________________.
_________________________________________
Signature of Notary and Authorized Official
Seal
Additional information on the Do-Not-Call Program, including a copy of the Program’s Rules and Regulations, can be obtained from the TRA Webpage
located at www.tn.gov/tra. All questions regarding the information on this application should be referred to (615)741-3939, ext. 162.
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