Verification Code Text Message Consent Form
Provide your details and consent to receive verification codes by text message.
Full Name
*
First Name
Last Name
Mobile Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address for Follow-Up
example@example.com
Service or Account Name
*
What are you verifying?
*
Please Select
Account sign-in
Account setup
A requested account change
Other verification
Preferred Language for Verification Messages
*
Please Select
English
Spanish
Other
Can this number receive text messages?
*
Yes
No
Are you authorized to use this phone number?
*
Yes
No
I understand that verification codes are intended only to verify my request and should not be shared with others.
*
I understand
Submit Consent
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