Third-Party Vendor Security Policy Acknowledgment Form
Please complete this form to acknowledge your understanding of our company's security policy prior to access or onboarding.
Vendor/Company Name
*
Primary Contact Full Name
*
First Name
Last Name
Primary Contact Email Address
*
example@example.com
Primary Contact Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Brief Description of Services Provided
*
Please select the type(s) of systems or data you will require access to:
*
Internal business applications
Customer data
Employee data
Financial records
IT infrastructure/systems
Other
Have you reviewed our company's security policy and procedures?
*
Yes, I have reviewed and understand the policy.
No, I have not reviewed the policy.
Have all relevant staff completed required security training or policy review?
*
Yes, all relevant staff have completed training/review.
No, training/review is in progress.
Not applicable (no additional staff involved).
Preferred method for reporting security incidents or concerns:
*
Please Select
Email
Phone call
Online portal
Other
Signature
*
Date
*
-
Month
-
Day
Year
Date
Submit Acknowledgment
Submit Acknowledgment
Should be Empty: