Permission to Hold a Public Event Lighthouse Marketing Group, Inc.

Permission to Hold a Public Event
Lighthouse Marketing Group, Inc.
Master ISO: Lighthouse Marketing Group
Date: _________________________
Agent Number: ______________
Event Time/Duration: _____________________
Event Address: _______________________________________________________________
Event City: _______________________ State: _______________ Zip: _________
Public Property: ____
Private Property: ____ (check one.)
I, _____________________________________________ (business owner/representative) hereby give my
permission to Lighthouse Marketing Group, Inc., a Master ISO for ___________________________, to
market at the address listed above. In the event of the sale of the business or property, this
agreement becomes null and void.
Permission is granted for: Single Event: ____ Multiple Events: ____ (check one)
Start Date:_______________
End Date:______________ Tel: ___________________
Company/Business Name: ___________________________________________________
Signature: ____________________________________ Title:_________________________
Specific instructions or rules the ISO must follow while marketing on the property:
______________________________________________________________________________
Please contact feel free to contact us at (214) 901-5265 with any questions. Lifeline is a
Government funded program through the Universal Services Administration Company
(USAC.gov). We are a licensed master distributer for the Eligible Telecommunication Carrier
whose name appears above.
AGENT AFFIRMATION:
I affirm that the contents of this document are accurate
and truthful to the best of my knowledge.
SIGNED:
FAX TO: 972-905-4292
(if applicable)
NOTARY:
DATE:
COMMISSION:
SEAL:
Email: [email protected]