TELEPHONE RECORDING CONSENT

(Date)

(Location)

I, ,
(Name)
, hereby
(Address)
authorize and

, employees of

________________________________________, to install a recording device on a telephone

(Company Name)

located at
(Location)

for the purpose of recording any conversation I might have on that telephone with

on or around .
(Name of Subjects) (Date)

I have given this written permission without threats or promises of any kind.

(Signature)

Witnesses: