Get To Know You Questionnaire

PhoneBurner Business Verification Form
Watch this brief video for a quick overview:
CONFIDENTIAL

Let’s get you the best answer rate possible! Providing the information in the form below will help PhoneBurner help you have more meaningful conversations.

What does PhoneBurner do with this information?
- Sections 1 and 2: We register your phone numbers with the three main mobile carriers so we make it known that you are a business making business phone calls, and you aren’t mistaken for a scam caller.
- Sections 1 and 2: We use this information to work with the carriers to resolve any false spam flags that may come up. We have strong relationships with the carriers, and clearing spam flags increases the chance you will reach the contacts you’re calling.
- Sections 3 and 4: We ask questions to learn more about your business, how you intend to use PhoneBurner, and how you plan to protect yourselves from violating telecommunications laws.
Collecting this information ensures that we comply with all legal requirements, protecting both you and our organization. Please note: you are required to provide updates to any information within 30 days of any change. Unfortunately, we will be unable to provide you with services if you are unable to complete this questionnaire.

Thank you in advance for your cooperation. Please review our Tips for completing the PhoneBurner Business Verification Form or schedule a 15-minute appointment with our team, and we can walk you through the process.
UID
UID v2
Primary Account Email
Section 1: Company Information

Please provide the full legal name of your company (e.g. the name used in incorporation).
Business Name*
Business Address*

Street Address

Street Address Line 2

CityState Abbreviation (2 Letters ONLY)

Postal / Zip CodeCountry
Entity Type:*
Public Entity Status:*
Industry*
Business Model (Business to Business, Business to Consumer, for example):*
Specify your business model:*
State of formation (2 Letter Abbreviation)*
Business Registration Type*
USA: Employer Identification Number (EIN)*
USA: DUNS Number (Dun & Bradstreet)*
Canada: Business Number (BIN)*
If you do not have a registered business, please explain. If you are a sole proprietor and have a professional license number, please add the number below.*
Is the company in "good standing" with state business registration (i.e., still considered active?)*

YesNoN/A
Explain why you chose N/A:
Number of years in business*
List the principal owner(s) of the company (i.e., those holding more than 10% of the equity of the company). If you do not know, write N/A:*
Business Website*
Section 2: Current Key Personnel
Primary Business Contact
Name*
Title*
Email*
Use the PRIMARY EMAIL ADDRESS associated with your PhoneBurner account.
Phone*
Primary Compliance Contact

This can be the same as the Primary Business Contact if applicable.
Is your Primary Compliance Contact the same as your Primary Business Contact?

Yes
Name*
Title*
Email*
example@example.com
Phone*
Section 3: How Will You Use PhoneBurner's Services?
Customers typically use the PhoneBurner Services in one or more of the following ways. Please indicate the model(s) you intend to use:
1. Direct: You will be making calls regarding your own products/services.*

YesNo
2.* On behalf of others: You will be making calls on behalf of a third party and its products/services.*

YesNo
3.* Third Party Use: You will permit third parties to use your PhoneBurner account to make calls (requires PhoneBurner approval).*

YesNo
*If you intend to use PhoneBurner for Business Process Outsourcing (BPO) services (as described in “Models” 2 and 3 above), then you are required to conduct similar due diligence on your customer.
When using PhoneBurner to provide telemarketing for products and/or services on behalf of third party sellers, will your company perform Know Your Customer due diligence on the third party? (Similar to what is covered by this Business Verification Form, in order to ensure the sellers are compliant with all laws and regulations?)*

YesNo
Who Is Calling?
Who are the individuals using your PhoneBurner account to make calls?
Employees*

YesNo
Independent contractors*

YesNo
Third Parties*

YesNo
What country(ies) are your calls originating from?*
What are you calling about?
Select the options below that describe the types of calls you are making:*

Attorney/LawFinancial ServicesFirst ResponderGovernmentHealth/HospitalInformationalPharmacy/Medical SupplyPolitical CampaignReal EstateSchool/CollegeSurvey/ResearchTelemarketingOther
What DBAs Are Being Used?
Please list the "DBAs" ("doing business as") that will be used in campaigns using the PhoneBurner Services. Please also list the state/county/city where registration of each DBA has been obtained. Not a required field.
What Products/Services are you marketing? Please list all products to be marketed using PhoneBurner (If you are not using PhoneBurner to market a product, please explain the purpose of your calls):*
Section 4: Detailed Questions & Requests
Company Information
1. Have you or your company been involved in any legal or regulatory matters in the past five years, specifically relating to telemarketing, teleservices, marketing, sales, or consumer protection?*

YesNo
Please provide a copy of the complaint or regulatory action and any resolution:*

Cancelof
2. Has your company or any of its key employees ever been involved in or acknowledged guilt in any legal case involving theft, fraud, violation of telemarketing laws, or the use of any false, deceptive, misleading, or unethical representation, action, or practice?*

YesNo
3. Is your company fully compliant with all necessary telemarketing or telephonic sales registration/licenses for the campaigns it will run using PhoneBurner services?*

YesNo
4. Does your company have a written telemarketing policy regarding compliance with applicable telemarketing laws, including, without limitation, the Telephone Consumer Protection Act, the Telemarketing Sales Rule and similar state laws?*

YesNo
Do Not Call Policy
You must have a written Do Not Call (DNC) Policy if you are engaging in telemarketing, per federal regulations. PhoneBurner does not have the capability to identify or prevent you from calling a number on the DNC list. Therefore, the responsibility to comply with DNC regulations lies with you.
1. Do you subscribe to the National Do Not Call registry?*

YesNoN/A
Describe why you chose N/A:*
2. Do you subscribe to State Do Not Call registries?*

YesNoN/A
Describe why you chose N/A:*
3. Do you honor all requests from consumers who wish to be placed on your company's specific Do Not Call list, as mandated by state and federal laws? PhoneBurner can help you maintain this list.*

YesNo
4. Do you keep customers on your Do Not Call list unless you have their consent or their number has been disconnected and reassigned to someone else?*

YesNo
(NOT REQUIRED) Please attach a written copy of your Do Not Call Policy.

Cancelof
Consent For Calls
Telemarketing calls/texts made to cell phones or residential lines using prerecorded voice require the called party's prior express WRITTEN consent as per federal regulations. Non-telemarketing calls/texts to cell phones using prerecorded voice require prior express consent.
Are you going to use PhoneBurner's prerecorded voicemail feature?*

YesNo
Telemarketing calls made to cell phones or residential lines using prerecorded voice require written permission from the party you are calling. Do you have the called party’s written consent to call them using a prerecorded voice?*

YesNo
When collecting a phone number and consent to use prerecorded voice, you must include all mandatory disclosures and a very clear indication that by providing their phone number, they consent to receive prerecorded calls. Where do you collect this consent?
Type a question
Please provide us with consent form(s). Not a required field.

Cancelof
Caller ID Practices
When you call your customers or prospects, what will they see on the Caller ID? (The customer or prospect must be able to call back the phone number that they see so they can get in touch with you.)*

I will use PhoneBurner-purchased numbers as my Caller IDI will use a mobile and/or office phone number(s) as my Caller ID
List the mobile and/or office phone number(s) you'll be using as your Caller ID:*
Separate phone numbers with a comma
PhoneBurner Robocall Policy
A robocall is defined as an automated telephone call initiated by a computer program using an auto-dialer or predictive-dialer where a pre-recorded message may be played to the US consumer. We have zero tolerance for illegal robocalling where, (1) calls are made from spoofed DIDs, or (2) calls to US consumers by fraudulently posing as a government agency, large corporation, or any other entity, with the intent to defraud a US consumer.
Affirmation*

I affirm that the information provided is accurate.I affirm that I will update the information provided whenever the information changes.I affirm that I and any person I permit to use my PhoneBurner account will comply with federal and state telemarketing laws and regulations, including the TCPA, the TSR, the Truth in Caller ID Act, and the Canadian Radio-television and Telecommunication’s Unsolicited Telecommunications Rules.I understand that any alleged or proven violations of any telemarketing law or consumer protection law may lead to my PhoneBurner Services being terminated.
Signature*

Clear
Date*

MonthDayYear
Should be Empty:

PhoneBurner Business Verification Form

Primary Business Contact

Primary Compliance Contact

Who Is Calling?

What are you calling about?

What DBAs Are Being Used?

Company Information

Do Not Call Policy

Consent For Calls

Caller ID Practices