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CPNI Form

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The FCC requires that we identify customers as being authorized to discuss information on your account. To do so, when you call or come into one of our stores, we will ask a specific question to which you have previously provided us the answer. Also, these rules require that we can only discuss account information with the person(s) authorized on the account. Please complete the form below to authorize up to four people on your account.

Name On The Account*
First Last
Account Number*
Identification Question*
Identification Question Answer*
Name of Person Authorizing This Change*
First Last
First Additional Authorized Person
First Last
Identification Question for First Additional Authorized Person
Identification Question Answer
Second Additional Authorized Person
First Last
Identification Question for Second Additional Authorized Person
Identification Question Answer
Third Additional Authorized Person
First Last
Identification Question for Third Additional Authorized Person
Identification Question Answer
Fourth Additional Authorized Person
First Last
Identification Question for Fouth Additional Authorized Person
Identification Question Answer
Comments
This field is for validation purposes and should be left unchanged.

CPNI Form

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