SMS consent form template for web and paper sign-ups
16 elements checkedRules read 2026-10-22Runs in your browser
Fill in your business, your program and what you will text. The builder writes the form a customer completes to join your text list: name, mobile number, an unticked consent box, the program details carriers look for and the federal written-consent wording, as a web form you can paste in or a paper form you can print for the counter. Every clause is tied to its source below. Nothing you type leaves this page.
Pre-filled with a two-chair salon's program. Change any field: the form, the code and the record follow.
Your form
Get texts from Harbor Lane Texts
Name
Mobile number
By checking this box, I agree to receive recurring automated marketing text messages from Harbor Lane Salon (Harbor Lane Texts) at the mobile number above, about last-minute openings, offers and new services. I authorize Harbor Lane Salon to send these texts using an automatic telephone dialing system or other automated technology. I am not required to agree to this as a condition of buying any property, goods or services. Up to 4 msgs/month. Msg & data rates may apply. Reply HELP for help, STOP to cancel. Texts come from (206) 555-0142.
By checking this box, I agree to receive account text messages from Harbor Lane Salon (Harbor Lane Texts) at the mobile number above, such as appointment reminders and confirmations. Message frequency varies. Msg & data rates may apply. Reply HELP for help, STOP to cancel. Texts come from (206) 555-0142.
Terms of service: https://www.example.com/sms-terms. Privacy policy: https://www.example.com/privacy.
Print gives you the paper version of this form, whichever view is open. The HTML is the web version, unstyled, so your site's own CSS dresses it; no box in it is pre-checked or required.
Harbor Lane Salon: text sign-up
Program: Harbor Lane Texts
Marketing texts. By ticking this box and signing below, I agree to receive recurring automated marketing text messages from Harbor Lane Salon (Harbor Lane Texts) at the mobile number above, about last-minute openings, offers and new services. I authorize Harbor Lane Salon to send these texts using an automatic telephone dialing system or other automated technology. I am not required to agree to this as a condition of buying any property, goods or services. Up to 4 msgs/month. Msg & data rates may apply. Reply HELP for help, STOP to cancel. Texts come from (206) 555-0142.
Account texts. By ticking this box and signing below, I agree to receive account text messages from Harbor Lane Salon (Harbor Lane Texts) at the mobile number above, such as appointment reminders and confirmations. Message frequency varies. Msg & data rates may apply. Reply HELP for help, STOP to cancel. Texts come from (206) 555-0142.
Terms of service: https://www.example.com/sms-terms. Privacy policy: https://www.example.com/privacy.
Office use: received by ________ on ________. Keep this signed form on file.
What it builds, clause by clause
An SMS consent form is the record that a person agreed to get your texts: who they agreed to hear from, about what, at which number, and how they stop. For marketing texts sent with an autodialer, the FCC asks for “prior express written consent” (47 CFR § 64.1200(a)(2)): “an agreement, in writing, bearing the signature of the person called” that names the number and carries two disclosures (§ 64.1200(f)(9)). CTIA's carrier guidelines ask for express written consent before promotional texts whatever the dialing technology: “Consumers may sign a form, check a box online, or otherwise provide consent to receive promotional text messages.” The form is your evidence if a text is ever disputed, and the statute allows $500 per call or text, up to three times that ($1,500) if the court finds the violation willful or knowing (47 U.S.C. § 227(b)(3)).
How to use it: set the business and program, pick marketing, account texts or both, pick web or paper, add your terms and privacy links, then copy the HTML or print the paper version. The record on the right counts the elements on the form and names any gap. The table reads the example's marketing box one clause at a time. For the federal definition in full, see prior express written consent; for the carrier side, the CTIA messaging guidelines.
| Clause, as the tool writes it | What it does | Source |
|---|---|---|
| “By checking this box, I agree to receive recurring automated marketing text messages from Harbor Lane Salon (Harbor Lane Texts) at the mobile number above, about last-minute openings, offers and new services.” | Names the seller, the program and what the texts are about, and ties the consent to the number on the form. One box covers one program from one sender. | 47 CFR § 64.1200(f)(9); CTIA § 5.1.1 (1), (3) and § 5.1.2.2 |
| “I authorize Harbor Lane Salon to send these texts using an automatic telephone dialing system or other automated technology.” | The first disclosure the federal definition requires: signing authorizes automated marketing messages to that number. | 47 CFR § 64.1200(f)(9)(i)(A) |
| “I am not required to agree to this as a condition of buying any property, goods or services.” | The second disclosure: the customer does not have to agree in order to buy anything. A form that makes texts a condition of a purchase fails this clause. | 47 CFR § 64.1200(f)(9)(i)(B) |
| “Up to 4 msgs/month.” | Says how many texts to expect; Twilio lists it on both its web and paper forms for campaign review. | Twilio web and paper lists; CTIA § 5.1.2.1 (4) |
| “Msg & data rates may apply.” | The fee disclosure CTIA asks for in clear language. | CTIA § 5.1.1 (4) |
| “Reply HELP for help, STOP to cancel.” | Customer care and the opt-out, in the standard words. | CTIA § 5.1.1 (5) and § 5.1.3 |
| “Texts come from (206) 555-0142.” | The number or short code the texts will come from. | CTIA § 5.1.1 (2) |
| Terms of service: https://www.example.com/sms-terms. Privacy policy: https://www.example.com/privacy. | Terms and privacy reachable from the sign-up itself, not buried elsewhere. | CTIA § 5.1.1 (5), § 5.2.1 |
| An empty checkbox, and a submit button (web) or a signature and date line (paper) | The customer's own act is the signature: the FCC accepts consent given on a website form under the E-SIGN Act, and Twilio's list says the box must not be pre-selected. | § 64.1200(f)(9)(ii); FCC 12-21 ¶ 34 |
Worked example: four counters, four forms
Four small businesses build their form with the tool. Each row is built and checked by the same functions the builder runs, so the count matches what the record shows for the same inputs. A missing link stops a form; a missing sending number or a switched-off disclosure is worth a second look.
| Business | Set-up | Boxes | Elements on the form | What the record says |
|---|---|---|---|---|
| Harbor Lane Salon | Web sign-up, offers and reminders | Marketing texts, Account texts | 16 of 16 | All 16 elements are on the form. Keep the same wording in your texting provider's campaign registration. |
| Corner hardware store | Paper form at the till, offers only, number not assigned yet | Marketing texts | 14 of 15 | Everything required is on the form. Worth a second look: sending number. |
| Dental office | Web sign-up, reminders only, terms page not written yet | Account texts | 12 of 13 | Fill in before the form goes live: terms link. |
| Food truck | Clipboard at the window, offers only, written-consent wording switched off | Marketing texts | 13 of 15 | Everything required is on the form. Worth a second look: automated texts authorized, not a condition of purchase. |
Web, paper or counter: what changes
The consent statement is the same on both; the way the customer signs and what you keep differ. When you register a 10DLC campaign, the provider asks how customers opt in, and Twilio, for one, asks for a link to the form or an image of it. Its campaign guide spells out what it expects on a web form and on a paper form, and the table puts the two lists side by side in its words. Twilio also says verbal consent “is not enough for marketing use cases.” Registration itself is covered in what is 10DLC and the 10DLC registration checklist.
This form is one channel. A keyword the customer texts in (“Text JOIN to …”) and the confirmation, HELP and STOP replies are written by the opt-in language builder; a consent form for sales calls as well as texts is the TCPA consent form builder.
| Element | Web sign-up | Paper or counter |
|---|---|---|
| Number | Phone number input field | Field for customer’s mobile phone number |
| Consent mark | Checkbox for consent (must NOT be pre-selected) | Checkbox or signature line for explicit consent |
| What they get | Clear description of the type of messages users will receive | Clear description of the texting service |
| Frequency | Message frequency information | Frequency of messages (e.g., “two messages per month”) |
| Rates | “Msg & data rates may apply” disclosure | “Msg & data rates may apply” disclosure |
| Help | Instructions for getting help (reply HELP for help) | Instructions for getting help (reply HELP for help) |
| Opt-out | Instructions for opting out (reply STOP to opt-out) | Instructions for opting out (reply STOP to opt-out) |
| Terms and privacy | Links to Terms of Service and Privacy Policy | Links to Terms of Service and Privacy Policy (or QR code linking to them) |
| Signing | Submit button with clear language (“Yes, sign me up!”) | Date field; Customer signature |
| Two programs | Marketing and transactional message consent must be consented to separately with two checkboxes | Not on the paper list; the tool keeps two boxes on paper too |
| Proof | For registration: a public link to the form, or a screenshot of it and of the page after submit if it is not live or sits behind a login | “You must keep physical copies of completed forms as records of consent. Do not discard signed forms.” |
CTIA counts “signing up at a point-of-sale (POS) or other Message Sender on-site location” as an opt-in, next to entering a number on a website. Whatever the format, it asks you to keep the time of consent, the medium, the language the customer saw, the campaign, the IP address, the number and who consented (§ 5.1.2). A tablet at the counter is a web form: it can log all of that. A paper form cannot log an IP address or a time, so the date line and the office-use line do that job.
State notes
The federal written-consent rule turns on an autodialer, and the Supreme Court read that term narrowly: a device must have “the capacity to use a random or sequential number generator to either store or produce phone numbers to be called” (Facebook, Inc. v. Duguid, No. 19-511 (U.S. Apr. 1, 2021)). Whether a given texting platform meets that test is a question for counsel; what is an autodialer walks through it.
Three state laws read on their legislatures' sites define written consent in their own words. Each names text messages and an “automated system for the selection or dialing of telephone numbers” (Florida says “selection and dialing”), not the federal random-or-sequential test. That is why the builder keeps the written-consent wording on by default. Other states: mini-TCPA state laws.
Written-consent definitions that name text messages
- FL
- OK
- MD
Consent authorizes a sales call “by telephone call, text message, or voicemail transmission” using “an automated system for the selection and dialing of telephone numbers”.
Section (8)(a) bars an unsolicited telephonic sales call made with such a system without the called party's prior express written consent.
Consent authorizes a sales call “by telephone call, text message, or voicemail transmission” using “an automated system for the selection or dialing of telephone numbers”.
Same four parts as Florida: signature, authorization, the number and the two disclosures. Paragraph 4 counts an electronic or digital signature.
Consent authorizes a sales call “by telephone call, text message, or voicemail” using “an automated system for the selection or dialing of telephone numbers”.
Subsection (e): a signature “includes an electronic or digital signature” valid under federal law or State contract law.
Sources
Every rule the builder encodes, with the date it was read. After sign-up, a customer can still revoke at any time; the words that count are in SMS opt-out keywords, and tools that store the consent record are compared in consent capture tools. This is a drafting aid, not legal advice.
- 47 CFR § 64.1200(a)(2) and (f)(9): prior express written consent (eCFR)fetched 2026-10-22
- FCC 12-21, TCPA Report and Order (Feb. 15, 2012), ¶ 34: consent under the E-SIGN Actfetched 2026-10-22
- CTIA Messaging Principles and Best Practices (May 2023), §§ 5.1–5.2.1fetched 2026-10-22
- Twilio, A2P 10DLC Campaign Onboarding Guide: web form and paper form opt-in listsfetched 2026-10-22
- Fla. Stat. § 501.059(1)(g) and (8)(a), Florida Telephone Solicitation Actfetched 2026-10-22
- 15 O.S. § 775C.2(3), Oklahoma Telephone Solicitation Act of 2022 (enrolled HB 3168)fetched 2026-10-22
- Md. Code, Com. Law § 14-4501(d)–(e), Stop the Spam Calls Act of 2023 (SB 90, ch. 413)fetched 2026-10-22
- Facebook, Inc. v. Duguid, No. 19-511 (U.S. Apr. 1, 2021)fetched 2026-10-22
- 47 U.S.C. § 227(b)(3): private right of action and damages (govinfo)fetched 2026-10-22