California Authorized Agent Designation

California Consumer Privacy Act

California residents have the right to designate an authorized person or corporate entity1 to exercise rights granted to them under the California Consumer Privacy Act (“CCPA”). To make this designation, California residents may complete and submit this form to Five Crowns Marketing.

If Five Crowns Marketing is unable to verify the identity of the person submitting this form, we may request additional information from the person making the submission. Authorized agents that have been provided a power of attorney from a consumer may submit requests directly on behalf of that consumer so long as proof of such power is submitted along with the consumer request form.

Asterisks indicate required fields.

Consumer's Information

The CCPA and this Agent Designation FORM applies to California Residents only.

Authorized Agent's Information

Please complete all the fields in this form and submit by clicking the button below.

1 If designating an entity to act on your behalf, Five Crowns Marketing requires that such entity be registered with the California Secretary of State. Five Crowns Marketing will not provide information to unregistered agents.

2 Five Crowns Marketing does not currently sell any personal information belonging to consumers and, therefore, does not permit and will not respond to requests to opt-out at this time.

Crown image