SMS Opt-In Consent Form


OUR BUSINESS
123 Main St  •  Anytown, US 12345  •  800-555-5555

SHORT MESSAGE SERVICE (SMS) OPT-IN CONSENT FORM

Customer Name: JOHN SMITH
Account Number: ____________________

ABOUT THIS FORM

Our Business offers, as an additional convenience to you, the ability to receive Short Message Service (SMS) text messages. Federal law requires that we obtain your separate, written consent before sending you text messages. Please read the descriptions below carefully and check only the box(es) that reflect the type(s) of messages you wish to receive.

You are not required to consent to receive any SMS messages as a condition of obtaining a loan or any other product or service from Our Business.

OPTION 1 — TRANSACTIONAL / ACCOUNT-RELATED SMS MESSAGES

TRANSACTIONAL

By checking the box below, I consent to receive transactional and account-related text messages from Our Business. These messages may include:

  • ●  Payment reminders and confirmations
  • ●  Account status notifications
  • ●  Loan servicing updates (e.g., due dates, balance information)
  • ●  Fraud alerts or security notifications related to my account
☐  Yes, I consent to receive Transactional / Account-Related SMS messages from Our Business at the cell phone number(s) listed below. I understand message and data rates may apply, message frequency varies, and that I may opt out at any time by replying STOP.

OPTION 2 — MARKETING & PROMOTIONAL SMS MESSAGES

MARKETING / PROMOTIONAL

By checking the box below, I consent to receive marketing and promotional text messages from Our Business. These messages may include:

  • ●  Offers for additional loan funds or refinancing opportunities
  • ●  Promotions, special offers, and new product announcements
  • ●  Other marketing communications from Our Business
☐  Yes, I consent to receive Marketing & Promotional SMS messages from Our Business at the cell phone number(s) listed below. I understand message and data rates may apply, message frequency varies, and that I may opt out at any time by replying STOP. My consent to receive marketing messages is not required as a condition of any purchase or service.

Please Note: You may consent to one or both categories independently. Checking one box does not automatically enroll you in the other. You may withdraw either consent at any time without affecting the other.

CONTACT INFORMATION

Cell Phone Number(s): ________________________________________________

E-Mail Address: ________________________________________________

AUTHORIZATION & SIGNATURE

By signing below, I confirm that I am the authorized user of the cell phone number(s) provided above, that I have read and understood the consent options selected, and that I agree to the SMS Terms & Conditions (sms-terms) and Privacy Policy (sms-privacy) of Our Business. I acknowledge that my signature may be in electronic, digital, or handwritten form to the extent recognized as valid under applicable federal or state law.

Printed Name: ____________________________
Date: ________________

Signature: ________________________________________________

HOW TO OPT OUT

You may withdraw your consent to receive SMS messages at any time, for either or both categories, by:

  • ●  Replying STOP from your cell phone to any SMS message you receive from Our Business
  • ●  Visiting one of our Our Business locations in person
  • ●  Calling us at 800-555-5555
  • ●  Writing to us at: Our Business, 123 Main St, Anytown, US 12345

Important: If your cell phone number changes, you are required to notify Our Business immediately by calling, visiting, or writing to us using the contact information above. You are liable for any violation of federal law resulting from your failure to notify us of a cell phone number change.