[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-277598-105":3,"detail-sidebar-cat-1-en-105":81,"doc-detail-277598-en":127},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","california-consumer-privacy-act-third-party-authorization-form","California Consumer Privacy Act - Third-Party Authorization Form","","California Consumer Privacy Act (CCPA) third-party authorization form for California residents requesting access, deletion, or correction of personal information through an authorized representative. The form collects consumer identity details (name, address, contact information) and requires completing at least three verification fields such as customer number, recent invoice/order information, or payment identifiers. It also records the authorized third party’s contact details, then includes a signed consumer declaration supported by a California notary acknowledgement to confirm representative authority.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/template/","Template",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/template/forms/","Forms",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/template/california-consumer-privacy-act-third-party-authorization-form/277598/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/california-consumer-privacy-act-third-party-authorization-form/277598.png","ImageObject",442,249,{"name":42,"@type":43},"Chumphorn","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-11-02","2026-09-15",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",13,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What does the CCPA Third-Party Authorization Form allow a requester to do?","Question",{"text":63,"@type":64},"It authorizes a third party to submit and receive a CCPA request on the consumer’s behalf, for access, deletion, or correction of personal information.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"How is the consumer identity verified on this form?",{"text":68,"@type":64},"The consumer must complete at least 3 verification fields (e.g., customer number, recent invoice/order details, payment identifiers). Requests may be denied if verification cannot be completed to a reasonable degree of certainty.",{"name":70,"@type":61,"acceptedAnswer":71},"What information is required for the authorized third party?",{"text":72,"@type":64},"The form requires the authorized third party’s name, street address, city/state/ZIP, and email address where the report will be sent.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},277598,1789502279,{"code":4,"msg":82,"data":83},"success",[84,89,94,99,104,109,113,118,123],{"id":85,"doc_module":22,"doc_module_name":25,"category_name":86,"show_sort_weight":87,"slug":88},11,"Presentations",90,"presentations",{"id":90,"doc_module":22,"doc_module_name":25,"category_name":91,"show_sort_weight":92,"slug":93},12,"Resumes",80,"resumes",{"id":95,"doc_module":22,"doc_module_name":25,"category_name":96,"show_sort_weight":97,"slug":98},14,"Invoices",70,"invoices",{"id":100,"doc_module":22,"doc_module_name":25,"category_name":101,"show_sort_weight":102,"slug":103},15,"Posters",60,"posters",{"id":105,"doc_module":22,"doc_module_name":25,"category_name":106,"show_sort_weight":107,"slug":108},16,"Social Media",50,"social-media",{"id":110,"doc_module":22,"doc_module_name":25,"category_name":29,"show_sort_weight":111,"slug":112},17,40,"forms",{"id":114,"doc_module":22,"doc_module_name":25,"category_name":115,"show_sort_weight":116,"slug":117},18,"Letters",30,"letters",{"id":119,"doc_module":22,"doc_module_name":25,"category_name":120,"show_sort_weight":121,"slug":122},21,"Paper Templates",5,"papers-templates",{"id":124,"doc_module":22,"doc_module_name":25,"category_name":125,"show_sort_weight":4,"slug":126},158,"General","general-158",{"code":4,"msg":82,"data":128},{"doc_id":79,"user_id":129,"nickname":42,"user_avatar":130,"doc_module":22,"category_id":110,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":30,"language":136,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":12,"update_tm":80,"read_time":22},2336475401981,"https://ap-avatar.wpscdn.com/avatar/22000c94efd8d5204d?x-image-process=image/resize,m_fixed,w_180,h_180&k=1786935347598174694","California Consumer Privacy Act  \nThird-Party Authorization Form  \nDear California Resident:  \nBefore we can fulfill an access or deletion request made by a third-party on your behalf, the California Consumer Privacy Act (CCPA) requires us to obtain evidence that you authorize the third-party to make the request on your behalf. Please use this form to authorize a third-party to submit and receive CCPA request on your behalf.  \nA. Request Type  \n□ Access Personal Information □ Delete Personal Information □ Correct Personal Information  \nB. Information About the Consumer Whose Information is Being Accessed or Deleted  \n\n| Name (first, middle, last) |  |\n| --- | --- |\n| Street Address |  |\n| City, State, Zip |  |\n| Phone Number | Email Address |\n| California Inmate No. (the CA inmate number for you, or the person you purchased a package for from Union Supply Direct) |  |\n\nC. Consumer Identity Verification  \nPlease complete at least 3 of the fields below so that we may verify your identity. For security purposes, we may deny all or part of your request if we cannot verify your identity to a reasonable degree of certainty.  \n1. Customer No:  [Located at the top left-hand side of your invoice]  \n2. Invoice \\# for any order placed with Union Supply Direct within the last 12 months:    \n[Located at the top right-hand side of your invoice]  \n3. Month and year of your last order placed with Union Supply Group:    \n4. Last 4 digits of your credit card number used to make a purchase with Union Supply Group within the last 12 months:    \n5. Check or money order number used to pay for a purchase with Union Supply Group within the last  \n12 months:    \nD. Authorized Third-Party Information  \n\n| Name of Third-Party (first, middle, last) |\n| --- |\n| Street Address |\n| City, State, Zip |\n| Email Address (this is the address the report will be sent to) |\n\nConsumer Declaration  \nI am a resident of the State of California. I am the individual listed above in Section B. Please accept this notarized declaration authorizing the third-party named above in Section D to act as my representative in connection with my request to access or delete my personal information under the California Consumer Privacy Act of 2018.  \nPlease send the requested information to the authorized third-party’s email address listed above in Section D.  \nI declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.  \nSignature:   Date:    \n(Must be signed in the presence of a notary)  \nCALIFORNIA NOTARY ACKNOWLEDGEMENT  \n(INDIVIDUAL)  \nA notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.  \nState of California  \nCounty of    \nOn   before me,   (insert name and title of the officer), personally appeared   , who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and  \nacknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.  \nI certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct.  \nWITNESS my hand and official seal.  \nSignature   (Seal)","cbCaitLYoCtkBqHr","https://ap.wps.com/l/cbCaitLYoCtkBqHr","pdf",164385,"English","# A. Request Type\n# B. Information About the Consumer Whose Information is Being Accessed or Deleted\n# C. Consumer Identity Verification\n# D. Authorized Third-Party Information\n# Consumer Declaration\n# California Notary Acknowledgement","[{\"question\":\"What does the CCPA Third-Party Authorization Form allow a requester to do?\",\"answer\":\"It authorizes a third party to submit and receive a CCPA request on the consumer’s behalf, for access, deletion, or correction of personal information.\"},{\"question\":\"How is the consumer identity verified on this form?\",\"answer\":\"The consumer must complete at least 3 verification fields (e.g., customer number, recent invoice/order details, payment identifiers). Requests may be denied if verification cannot be completed to a reasonable degree of certainty.\"},{\"question\":\"What information is required for the authorized third party?\",\"answer\":\"The form requires the authorized third party’s name, street address, city/state/ZIP, and email address where the report will be sent.\"}]","California Consumer Privacy Act - Third-Party Authorization Form | PDF"]