Legal CPNI Form

LEGAL CPNI AUTHORIZATION AND RELEASE

This Customer Proprietary Network Information Authorization and Release (the "Authorization") is made effective as of by and between Customer Name: (the "Customer") and Service Provider Name: (the "Service Provider").

Customer Account Number: Service Address:

RECITALS

WHEREAS, Customer is a subscriber to telecommunications and related services provided by Service Provider and possesses Customer Proprietary Network Information ("CPNI") as defined under applicable law and Service Provider policy; and

WHEREAS, Customer desires to authorize the disclosure and use of specified categories of CPNI to the persons and entities identified in this Authorization for the limited purposes set forth below; and

WHEREAS, Service Provider is willing to disclose CPNI only in accordance with the terms, limitations, and verification procedures contained herein.

NOW, THEREFORE

In consideration of the mutual covenants contained herein, and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the parties agree as follows:

1. DEFINITIONS

"CPNI" means information that relates to the quantity, technical configuration, type, destination, location, and amount of use of a telecommunications service subscribed to by Customer, as well as calling patterns and billing information, as further defined by applicable law and Service Provider policy.

2. AUTHORIZATION AND CONSENT

Customer hereby authorizes Service Provider to disclose Customer's CPNI to the third-party recipient(s) identified in Section 4 and to use Customer's CPNI for the permitted purposes described in Section 3, subject to the terms, verification procedures, limitations, and duration set forth herein. This Authorization constitutes an affirmative, written, and signed consent by Customer.

3. SCOPE OF INFORMATION TO BE DISCLOSED

Customer authorizes disclosure of the following categories of CPNI (check all that apply):

Call detail records (dates, times, numbers called)

Billing and payment history

Service plan and product subscriptions

Location information and provisioning data

Network configuration and technical performance data

Marketing preferences and account management details

4. THIRD-PARTY RECIPIENTS

5. PURPOSE AND METHOD OF DISCLOSURE

Customer expressly authorizes disclosure and use of CPNI for the following purposes (check all that apply) and for no other purposes absent further written consent:

Account support, troubleshooting, and technical assistance

Billing inquiries and payment processing

Service provisioning, transfers, and order management

Other (specify below)

6. METHOD AND VERIFICATION

Authorized methods of disclosure: Written release Verbal verification Electronic delivery

7. DURATION AND REVOCATION

This Authorization shall commence on and shall remain in effect until unless earlier revoked by Customer in writing in accordance with Section 8.

Revocation Procedure: Customer may revoke this Authorization by delivering written notice to Service Provider at the notices address set forth in Section 10. Revocation will be effective upon Service Provider's receipt, except to the extent Service Provider has already relied upon this Authorization prior to receipt.

8. CUSTOMER REPRESENTATIONS

Customer represents and warrants that Customer is the authorized account holder or authorized representative of the account referenced in this Authorization and has full power and authority to execute this Authorization. Customer further represents that all information provided herein for verification purposes is true and accurate.

9. SERVICE PROVIDER OBLIGATIONS AND LIMITATIONS

Service Provider will disclose CPNI only in accordance with the scope and purposes set forth in this Authorization and will use commercially reasonable measures to protect CPNI against unauthorized access, disclosure, or use. Service Provider will retain a record of disclosures made pursuant to this Authorization in accordance with its normal retention practices.

10. INDEMNIFICATION

Customer shall indemnify, defend, and hold harmless Service Provider and its affiliates, officers, employees and agents from and against any claims, liabilities, losses, damages, costs and expenses (including reasonable attorneys' fees) arising out of or resulting from (a) any false or misleading representations made by Customer in this Authorization, or (b) any unauthorized use or disclosure of CPNI caused by Customer's failure to comply with verification procedures provided herein.

11. NOTICES

Notices under this Authorization shall be in writing and delivered by hand, certified mail, or nationally recognized courier to the addresses above and shall be effective upon receipt.

12. GOVERNING LAW

This Authorization shall be governed by and construed in accordance with the internal laws of the state or jurisdiction in which Service Provider maintains its principal place of business, without regard to conflict-of-law principles.

13. ENTIRE AGREEMENT; SEVERABILITY

This Authorization constitutes the entire agreement between the parties with respect to the subject matter herein and supersedes all prior and contemporaneous agreements, understandings and communications, whether written or oral. If any provision of this Authorization is determined to be invalid or unenforceable, the remaining provisions shall remain in full force and effect.

14. AMENDMENTS; WAIVER; COUNTERPARTS

No amendment or waiver of any provision of this Authorization shall be effective unless in writing and signed by both parties. Failure by either party to enforce any provision of this Authorization shall not be deemed a waiver of future enforcement of that or any other provision. This Authorization may be executed in counterparts, each of which shall be deemed an original and all of which together shall constitute one instrument.

15. CERTIFICATION

By signing below, Customer certifies under penalty of perjury that Customer is authorized to make this Authorization for the account identified above, that the information provided for verification is accurate, and that Customer understands the scope, duration, and consequences of this Authorization. Service Provider's acceptance of this Authorization is conditioned upon satisfactory verification of Customer identity and authority.

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