California Agent Request Form

The California Consumer Privacy Act permits California residents to authorize agents to make privacy requests on their behalf. Authorized agents can make access, deletion, and correction requests.

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 to submit your request.

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Authorized Agent's First & Last name
Consumer's First & Last Name
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.
Click or drag a file to this area to upload.