Consumer Right to Know (Access), Delete, or Correct Form CCPA Form I Am Submitting the Following Request on Behalf Of: * Myself On Behalf as an Individual as an Authorized Agent Please Select the Type of Request: * Right to Know / Access Request Deletion of My Personal Data Correction of Personal Data in Our Possession Opt-Out of Sale of Personal Information Contact Information of Consumer Subject First Name: * Last Name: * My Email: * My Phone: Street Address: City: State: Zip Code: Please Indicate My Preferred Method of Communication: * Email Phone/Text Mail Please Provide Information That May Be Helpful In Processing Your Request: Information on Requestor if Different Than the Consumer Subject (Authorized Agent) First Name: Last Name: Organization Name (If Applicable): Relationship to Consumer Subject: City: State: Zip Code: Phone Number: Email: By submitting this request, I declare under penalty of perjury that I am the consumer or authorized agent whose personal information is the subject of this request. Prior to processing your request, we may contact you, or your authorized agent to verify your identity. The information provided will be used to process your request and will not be used for marketing purposes.* Signature * Date of Signature If you are human, leave this field blank. SEND
