I, __(NAME)__________________________, hereby appoint __(AGENT)__________________________ as my third party-designee and authorize Agent to make a request pursuant to the California Consumer Privacy Act (CCPA) on my behalf. I further authorize Agent to correspond with Duraco Specialty Tapes LLC (Duraco) and its employees, agents, affiliates, officers, directors, or representatives on my behalf in all matters with respect to communications relating to the CCPA.
I hereby agree to notify Duraco in writing of any cancellation of this Agent Authorization Statement. Such notices should be emailed to Duraco:
firstname.lastname@example.org or sent via postal mail to: 7400 Industrial Drive, Forest Park, IL 60130.
IN WITNESS WHEREOF, the undersigned has executed this Agent Authorization Statement in__(CITY)_______________________, California on __(DATE)_________________.