Authorized Agency Application - About LiftBase Data

In compliance with CCPA (and similar regulations), LiftEngine allows Authorized Agencies to submit requests to delete, correct, or know about personal information on behalf of US consumers. To become an authorized agency, an individual with the capacity to represent the organization must complete the form below.

You can Apply in Either of Two Ways

Online (fastest): Complete the form below and upload your agency’s Certificate of Good Standing, issued by its US state or territory of incorporation.

By mail: Send a letter on your agency’s letterhead with the information requested in the form below, signed by the contact person and stating that your agency agrees to the Terms & Conditions below. Include a copy of your Certificate of Good Standing. Mail it to:

Either way, we will email your contact person to complete verification. Please use an address that one person monitors. Once approved, submit each consumer request through our online form at Your Privacy Choices, with the consumer’s signed written permission attached.

Authorized Agency Request

"*" indicates required fields

URL

This field is for validation purposes and should be left unchanged.

Legal Name of Agency*

Trade Name(s) / DBA(s)

Any names your agency operates under, such as your brand or service name.

State of Incorporation*

Agency Address*

Street Address Address Line 2 City State ZIP Code

Agency Website*

Certificate of Good Standing*

Issued by your state of incorporation.

Accepted file types: pdf, Max. file size: 50 MB.

Email Address(es) or Domains Your Agency Sends Requests From

Application Contact Information

Name*

First Last

Title*

Your role at the agency.

Email*

We will use this address to complete your application. No distribution lists are allowed for the verification process. Any obvious distribution lists will cause the application to be denied.

Phone*

Terms and Conditions

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