CCPA Authorized Agent

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Authorized Agent Designation

CCPA

California residents have the right to designate an authorized person or corporate entity to exercise rights granted to them under the California Consumer Privacy Act (CCPA). To make this designation, California residents may complete and submit this form. To the extent we are unable to verify the identity of the person submitting this form, we may request additional information from the person making the submission. Authorized agents that have been provided a power of attorney from a requestor may submit requests directly.

Name*
First Last
Date of Birth*
MM slash DD slash YYYY
Current Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Name of Authorized Agent^*

^If designated an entity to act on your behalf, the CCPA requires that such entity is registered with the Secretary of State. WFI will not provide any information to unregistered agents.
Should any information requested by the authorized agent be delivered to the agent or you? Please provide delivery instructions.
I hereby give my authorization for the agent identified above to make the following types of requests on my behalf:*
- Requests to konw information regarding the personal information we maintain about you.
- Requests to delete personal information we collected from you.
Print Name*
Signature*