Consumer Authorization Form

A signed authorization that lets a business collect, store, and use a client's personal information to deliver services, with the client able to name an assisting agent and revoke consent at any time.

Use this template

Client or authorized representative granting authorization

Nombre

Apellido

Client or authorized representative email

Date authorization given

Assisting Agent

Nombre

Apellido

I authorize ACME and its licensed agents to collect, store, and use my personal information as needed to carry out their duties as a licensed sales agent. I understand this authorization may be revoked at any time by notifying ACME or my agent.

I authorize I do not authorize

Signature

Sign here

Consumer Authorization Form

Related templates