Personal Account - Authorization And Password Selection Form printable pdf download

Account Number:__________________

PERSONAL ACCOUNT – AUTHORIZATION AND PASSWORD SELECTION FORM

Authorization to Access Account

I, as the person financially responsible for the above account, hereby designate and authorize those individuals listed below to

share in all of the rights and privileges that I have in and to the above-referenced account, such rights including, but not limited

to, the right to access account information and call record details, change rate plans, add or delete features, extend terms of

service, upgrade and deactivate accounts, add new lines, and open new accounts. I hereby further agree that, notwithstanding

the authorization(s) granted hereby, I shall remain solely responsible for all charges to the account listed above and for any new

accounts which I or any of the following individuals may open pursuant to this authorization. This designation shall remain in

effect until cancelled by me in writing.

Names of individuals authorized pursuant to the foregoing: (Must be at least 18 years of age.)

______________________________

_______________________________

______________________________

Authorized Person (print)

Authorization to Remove Account Access

I, as the person financially responsible for the above account, hereby authorize removal of the individual(s) listed below from

access to the account. I understand that by removing the individual(s) listed below, they will no longer have any access to the

account including, but not limited to, making changes to the account and requesting any account information.

Names of individuals removed pursuant to the foregoing:

______________________________

_______________________________

______________________________

Authorized Person (print)

Request for Password/Secret Question

I request the password and secret questions indicated below be added to or changed on my account. I understand that I or any

authorized individuals on my account may be asked to verify this password/secret question when contacting an Nsight

representative regarding the above-mentioned account.

Password:

The password must be between 4 and 16 characters

Secret Questions: Select (x) TWO of the secret questions shown below, and enter your answers in the boxes provided.

___What was your first job?