Agent Request Form

If you are an authorized agent making a request, please provide the information below so that we may process the request. To submit a request by phone, please call (866) 440-3644. Please note that we might communicate with the consumer at the consumer’s contact information you provide in order to conduct certain verification procedures directly with the consumer.

If you are making this request for yourself, please do not use this form. Instead, please visit Individual Request Form to submit your request.

Select request type(s)*

If you chose “correct my personal information” or “delete my personal information,” please identify what personal information you would like us to correct or delete.

Authorized Agent's company name (if applicable)

Authorized Agent's First & Last name*

First

Last

Agent's contact email address*

Consumer's First & Last Name*

First

Last

Consumer's contact Email*

Please use the button below to upload written permission signed by the consumer documenting that you have been authorized by the consumer to make this request. This written permission must include the consumer’s full name, email address, and authorization for you to act on the consumer’s behalf in making the request. If the consumer has provided you with power of attorney pursuant to California Probate Code sections 4121 to 4131, you may instead upload a copy of the validly executed power of attorney naming you as the consumer's authorized representative.

File Upload*

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