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By my signature via entry of my name and consent via checkbox below, I certify that I am the person identified as the “client” and that I hereby authorize and its directors, managers, employees and contractors controlled by (collectively “Privacy Pros”), the following:

I hereby request and authorize Privacy Pros to identify and remove my personal information from the Internet and public databases including; white page site listings; people search sites; people aggregation sites; consumer-level background check and credit reporting sites; reverse email, phone lookup and  reverse address sites; genealogy research sites; real estate background sites; contact databases for generally understood undesirable or sex related sites; dark web/TOR-accessed people search and data mining sites; and all other public Internet information as set forth in the level of service chosen and as indicated on Privacy Pros website.


I authorize Privacy Pros to create an anonymous email account in my name that can be used by Privacy Pros to demand removal of my personal information via letters, online form completion, faulty link/dead link submission requests to search engines, and other correspondence as is required on my behalf in order to protect my privacy and remove personal information.

I will provide Privacy Pros with the following information, to be used to remove such information from Internet and public databases:

  • Full legal name; all variations on name that I have used in the past

  • Birthdate (month, day and year)

  • Current and past addresses

  • All email addresses that I use or have used.

  • All phone numbers that I use (cell, office, home, etc) and past phone numbers.

  • A copy of the information on my driver's license or identification card.

  • Such other related information as determined necessary to perform the services.


I understand that Privacy Pros must comply with timeframes and removal procedures established by law and/or by each data company.  I understand that Privacy Pros will undertake its duties diligently, but is not responsible or liable for delayed responses, website errors, website bankruptcy actions, acts of God, or other factors beyond Privacy Pros’ control.  I understand that Privacy Pros will make repeated requests when initial requests are ignored or unsuccessful, and follow up with related due diligence actions during the service term, and that such actions may include complaints on client’s behalf to the Federal Trade Commission or other government agencies and major search engines to the degree deemed appropriate by Privacy Pros to achieve client privacy protection.

I understand that certain information cannot be removed and that Privacy Pros will not pursue, nor be liable for, personally identifiable information within professional business listings, government sites (e.g. .gov, .mil, or any government paid but privately owned sites for government services), voter registration sites, Government office visitor logs (eg. White House), social media, blogs/vlogs, personal websites, newspaper/news/media sites, arrest record sites, resume sites, company directories, printed materials, religious directories, opted-in sites (e.g. wedding, baby or funeral registries), online obituaries,  and aggregators of the above sites. Notwithstanding, Privacy Pros may attempt removal of that information to the extent permitted by law.


I understand that Privacy Pros is removing information from public websites and has no ability to remove information from my own devices or cached information of smart phones, tablets and other client devices used to stream services, television viewing activity or Internet usage data. 

I understand that Privacy Pros security procedures and Privacy Policy are designed to protect client information.  Privacy Pros does not, and will not, share, sell or disclose client’s personal information.  Such information will only be used by Privacy Pros to the extent needed to identify, verify and remove client’s name and personal information from public sites.  The Privacy Policy can be reviewed here Privacy Policy . This document constitutes a Release of information given to Privacy Pros solely to provide services to Client, and shall be binding upon the undersigned, and his respective heirs, executors, administrators, personal representatives, successors and assigns. 


This Authorization and Release, together with the description of services on the website, the Privacy Policy, and Privacy Pros acceptance of payment made by Client shall constitute the Agreement by Client and Privacy Pros for service.  Service may be terminated by Client at any time upon notice to Privacy Pros. Violation of terms by Client shall be grounds to terminate service by Privacy Pros upon notice sent to the email address provided by Client.  


I  represent that I am over the age of 18 and that the information provided by me is true, accurate and up to date, and that I will comply at all times with the terms set forth and applicable law. In the event of dispute or legal action, the maximum liability of Privacy Pros to Client shall not exceed the amount paid by Client for service.  Client agrees to indemnify, defend and hold harmless Service Provider from and against all claims, liabilities, damages, losses that such parties may incur as a result of Client’s violation or breach of any representation or obligation under this Agreement. Privacy Pros is only obligated to provide services during the period for which it has been paid. This Agreement is subject to and governed by the laws of the State of Nevada.


By filling out the following forms, I certify that I am the Client listed in this authorization form; that I agree to the terms above; and I authorize Privacy Pros to proceed with service on my behalf.

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