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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(Required)

First Last

Account Number(Required)

Identification Question(Required)

Identification Question Answer(Required)

Name of Person Authorizing This Change(Required)

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 Fourth Additional Authorized Person

Identification Question Answer

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