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Sales Authorization and CPNI Consent Form

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Sales Authorization and CPNI Consent Form

Verizon Partner Program

For use in Commercial and Public Sector Accounts

Customer Name
Address
Phone Number
Customer Signature
Print Name
Title
Effective Date

Under the terms of this form, you authorize , a participant in the Verizon Partner Program and sales agent of Verizon ("Authorized Representative"), to submit requests and review account information including CPNI as defined below, pertaining to services your company purchases from Verizon. You further authorize Verizon Companies* to provide such information directly to the Authorized Representative, noting this authorization does not prevent you from acting on your own behalf whenever you deem it necessary.

List all Billing Telephone Numbers (Use separate sheet for additional BTNs, Check here if used):

* Billing Telephone Number or BTN shall include all current and any new working telephone numbers added after the effective date of this authorization.

Also, in order to better serve your company and offer you additional products and services, Verizon Companies* may need to share information about you as described below.

The Federal Communications Commission and various states require the Verizon Companies to protect certain information relating to the quantity, technical configuration, type, destination, location, and amount of use of your telecommunications and interconnected VoIP services purchased from the Verizon Companies and related local and toll billing information ("CPNI"). The Verizon Companies acknowledge that we have a duty, and you have a right, under law to protect the confidentiality of your CPNI.

By signing this form, you grant the Verizon Companies, solely for the purpose of offering you current and future products and services available from the Verizon Companies permission to use, to permit access to, and to disclose your CPNI and Confidential Information ("CI") among ourselves, and to our agents, contractors and partners who assist us in providing such products and services to you and who have an obligation to protect such information.

You have a right to disapprove of the uses of CPNI and CI as set forth above, and you may withdraw consent at any time by notifying us in writing at cpni-notices@verizon.com. Your consent will remain valid until we receive such a notice withdrawing consent. If you refuse or withdraw consent for use or disclosure of your CPNI and CI, it will not affect our provisioning of services to which you subscribe. You also understand that the authorization above will remain effective until modified and/or revoked, in writing to Verizon, by you or your authorized representative, or if an Authorized Representative ceases to be a participant in Verizon’s Indirect Sales Program.

Signature

Date

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What the Sales Authorization and CPNI Consent Form Is

The Sales Authorization and CPNI Consent Form documents a customer's permission to allow sales and marketing access to Customer Proprietary Network Information (CPNI) and authorizes specified sales activities on the customer's account. It combines a sales representative authorization with a privacy consent mechanism so providers can lawfully use and disclose call detail, billing, and service information for marketing or third-party sales. For U.S. transactions, this form is commonly used by telecommunications carriers and service resellers to meet company policy and regulatory obligations while capturing clear, auditable consent.

Why a Clear Consent Form Matters for Sales and Privacy

A properly completed Sales Authorization and CPNI Consent Form documents consent, reduces disputes, and supports compliance with federal privacy and e-signature laws such as the ESIGN Act (15 U.S.C. ch. 96) and industry rules governing CPNI. Accurate forms protect both the customer and the provider by recording who may act on an account and what categories of information can be used for sales or marketing.

Why a Clear Consent Form Matters for Sales and Privacy

Typical Users and Signers

Organizations that collect CPNI and execute sales on behalf of customers commonly use this combined authorization and consent form to capture permissions and delegate sales authority.

  • Telecommunications carriers and resellers who must document CPNI permissions and sales authorization for account representatives.
  • Customer service or sales agents who need delegated authority to negotiate rates, make plan changes, or accept marketing offers on behalf of an account holder.
  • Compliance, legal, or recordkeeping teams maintaining an auditable trail of consent and authorization for regulatory review.

Keep completed forms with customer records and make retention decisions based on regulatory and business needs described below.

Who May Sign and Their Roles

Primary Account Holder

A legally recognized account owner or authorized business officer who can provide written consent for use of CPNI and grant sales authority. The primary account holder should sign using the name that appears on government-issued ID to ensure identity verification during audits or disputes.

Authorized Agent

An individual designated by the account holder—often via power of attorney, company resolution, or signed authorization—to act on the account. Agents must be clearly identified and include their title and contact details; companies should verify authority before accepting agent signatures.

Essential Data Elements to Collect

Customer Name: Full legal name
Account Number: Carrier account ID
Service Address: Street address
Authorized Person: Name and title
Consent Scope: Marketing categories
Effective Date: MM/DD/YYYY

Key Risks and Regulatory Consequences

Regulatory Violation: Fines and enforcement
Privacy Breach: Loss of consumer trust
Contract Dispute: Sales authority challenged
Service Interruption: Account access revoked
HIPAA Exposure: Health data risks
Retention Failure: Records missing at audit

Common Preparation Errors to Avoid

  • Using informal initials or nickname instead of the signer’s legal name can create identity disputes during compliance reviews or account transfers.
  • Missing or incorrect account numbers prevent matching consent to the right customer record and may invalidate the authorization for automated systems.
  • Vague consent scope language such as 'marketing materials' without defined categories leads to ambiguity about allowable disclosures and third-party sharing.
  • Failing to document the signer’s relationship to the account (owner, agent, POA) can permit later challenges to the agent’s authority.

Step-by-Step: Completing the Form

Follow these sequential steps to complete and verify a Sales Authorization and CPNI Consent Form so it will be auditable and defensible in compliance checks.

  • 01
    1. Identify: Enter customer legal name and account number.
  • 02
    2. Define Scope: Specify CPNI categories and permitted sales activities.
  • 03
    3. Verify Identity: Use ID check, KBA, or two-factor methods.
  • 04
    4. Sign & Date: Signer signs and dates in MM/DD/YYYY format.

How Authorization and Consent Flow Works

This flow outlines document routing from capture to record retention so each party and action is traceable for compliance.

  • Capture: Form completed by customer or rep and initialed.
  • Authenticate: Identity verification recorded with method.
  • Store: Signed copy saved in customer record.
  • Audit: Access and changes recorded in an audit trail.

Core Elements a Professional Form Should Include

A compliant Sales Authorization and CPNI Consent Form includes discrete sections that make permissions and delegations explicit while enabling reliable verification and retention.

Clear Consent

A labeled consent section that lists CPNI categories (billing, call detail, location) and explicitly states how the information may be used or shared for marketing and sales purposes.

Authorized Actions

A defined authorization block that specifies the sales actions allowed (plan changes, contract negotiation, order placement) and any monetary thresholds or limitations on the agent's authority.

Identity Proofing

A recorded identity verification method—KBA, ID scan, or multi-factor authentication—plus the verifier’s name and timestamp to support attribution in audits.

Retention Statement

A short clause indicating how long the consent record will be kept and how the customer can revoke consent, aligned with company recordkeeping policy and legal retention obligations.

Signature Block

Designated signature lines for the account holder and any agent, each with printed name, title (if applicable), date, and a statement of capacity to sign.

Revocation Process

Instructions describing how the customer may withdraw consent, required notice period, and the effect of revocation on pending sales actions.

Recommended Digital Workflow Settings

Configure your eSignature workflow to capture identity, consent, and an immutable audit trail for each signed Sales Authorization and CPNI Consent Form.

Field Configuration
Signature Field Required; date auto-fill; signer name locked
Identity Check SMS code or KBA before signing
Consent Checkbox Explicit opt-in; cannot be pre-checked
Audit Trail Capture IP, timestamp, and method

Digital Delivery and Integration Considerations

Confirm your chosen platform supports secure storage, audit logs, and integrations required to tie signed forms to customer records.

  • File Formats: PDF, DOCX supported
  • Integrations: CRM connectors like Salesforce
  • Authentication: SMS, KBA, SSO options

Timing, Deadlines, and Processing Expectations

There is no single federal filing deadline for a Sales Authorization and CPNI Consent Form, but timely processing and retention support compliance and customer service goals.

Immediate Capture:

Obtain consent before performing any marketing or sales activity that uses CPNI.

Verification Window:

Verify identity at the time of signing to ensure attribution and auditability.

Processing Time:

Allow 24–72 hours for internal routing, verification, and recording in the customer system.

Renewal Review:

Consider annual reconfirmation for ongoing third-party marketing consent.

Revocation Effect:

Specify the effective date for revocation and whether it applies prospectively or retroactively.

eSignature Vendor Comparison for This Form

Compare typical vendor capabilities and starting prices for electronic signing solutions that can capture consent, identity checks, and audit trails; signNow is listed first per comparison conventions.

signNow DocuSign Adobe Sign PandaDoc HelloSign
Starting Price $8/user/mo $15/user/mo $14/user/mo $19/user/mo $15/user/mo
Free Trial 7-day free trial Yes Yes Yes Yes
Bulk Send Yes Yes Yes Yes No
Audit Trail Yes Yes Yes Yes Yes
HIPAA Compliant Yes Yes Yes No No

Frequently Asked Questions and Troubleshooting

Answers to common questions about form validity, revocation, identity verification, retention, and electronic signing to reduce implementation friction.


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