RevenueWell Authorized Agent Request

Authorized Agent Request

Step 1 of 2 – About the Agent

You must be an authorized agent with a license to practice in California in order to complete this form.

About the Agent

Attach a power of attorney or signed authorization form
Accepted file types: pdf, Max. file size: 300 MB.
Certification of Authorization(Required)

Third-Party Requests

Third-parties submitting requests on another’s behalf should submit a signed power of attorney or other documentation signed by the data subject on whom the request is being submitted proving the agent’s authority to submit a request on the data subject’s behalf. If provided, we will retain your documentation for no longer than necessary. We reserve the right to deny requests from persons or businesses claiming to be authorized agents that do not submit sufficient proof of their authorization. State-specific limitations may apply to requests by agents.