Authorized Agency Application - About LiftBase Data

In compliance with CCPA (and similar regulations), LiftEngine allows Authorized Agencies to make “Request to Know” inquiries on behalf of US Consumers. To become an authorized agency, an individual with the capacity to represent the organization must complete the form below.

Authorized Agency Request

"*" indicates required fields

Legal Name of Agency*

Agency Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Certificate of Good Standing*

Must be in a US state or territory.

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

Application Contact Information

Name*

First Last

Email*

No distribution lists are allowed for the verification process. Any obvious distribution lists will cause the application to be denied.

Phone*

Terms and Conditions

Comments

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