Authorized Agent Request

Agent type *

Agent organization

Required if the agent is a company, law firm, or privacy service.

Agent mailing address

Consumer state of residence *

Request type *

Proof of authorization *

Upload signed authorization, power of attorney, guardianship document, or other proof (PDF, JPG, PNG, DOCX).

Consumer verification method *

Consumer will verify by emailSigned authorization attachedPower of attorney attachedOther

Certification by agent *I certify I am authorized to submit this request and will provide additional proof if requested.

Consent to contact consumer *Astoria may contact the consumer directly to verify authorization where permitted or required.

Certification *I certify the information provided is accurate and that I am the individual identified or authorized to submit this request.

Verification *

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