Authorized Agent Designation Form

Instructions:

If you would like to designate an authorized agent to submit a request on your behalf related to your personal information, or if you are an authorized agent yourself, a signed copy of this form must be submitted to us. If we are unable to verify the identity of the individual about whom information is being requested (the “Requestor”), we may ask for additional information or documents for verification purposes. For more information, please see our Privacy Notice.

If sending by mail, please use the following address:

Apollo Jets LLC, 9 W 37th Street, 8th Floor, New York, NY 10016

If sending by email, please use the following address:

privacy@vistaglobal.com

Authorized Agent Designation Form
Requestor Information
Authorized Agent Information

Authorization

I, Requestor, designate the Authorized Agent listed above for the sole purpose of submitting the following request(s) on my behalf (check all that apply):

Checkboxes

By signing below and submitting this Authorized Agent Designation form, I affirm the following:

 

  • I am the Requestor whose name appears above, and the information provided in this form is true and accurate.
  • I understand that I may be contacted directly in order to verify my identity and confirm designation of my Authorized Agent.
  • I grant the Authorized Agent permission to submit the request(s) indicated above to Apollo Jets on my behalf.
  • I authorize Apollo Jets to process such request(s) and I understand that any responses produced in connection with a request to access my personal information will not be sent to my Authorized Agent but will instead be sent directly to me at the address provided above.
  • The authority granted by this form will terminate 90 days after the date of execution.
  • I agree to indemnify Apollo Jets for any and all claims that arise against Apollo Jets in relation to its reliance on this Authorized Agent Designation form.

Please note, if you are designating an entity to act on your behalf, California law requires that such entity is registered with the Secretary of State.