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Client-Directed Authorization

Control what Imperium may share and with whom.

This form records a client's direction, authorized professional, information categories, purpose, date, expiration, and affirmative action. Imperium must validate the request and apply privacy-policy and legal requirements before any disclosure.

Information categories I authorize Imperium to share *
Revocation: Submit this form again with the revocation request or request revocation through Contact Us. Revocation applies prospectively after Imperium verifies and processes the request.