CCPA Consumer Request Form

CCPA Consumer Request Form

Your Name:

Your Email:

Your City and State of Residence:

Please Select Who the Request Is Being Made For:

MyselfOn behalf of a California resident, I am their Authorized Agent

If you are completing this form as an Authorized Agent, please complete and send us a California Authorized Agent Designation Form.

If you are submitting this form as an Authorized Agent, please complete the following information:

Consumer Name:

Consumer Email:

Consumer City and State of Residence:

Access RequestData Portability RequestDeletion Request

By checking “I Accept” below, you acknowledge and certify that the information you have entered into this form is complete and accurate to the best of your knowledge and that you are either (a) a California resident making this request on behalf of yourself; or (b) an Authorized Agent making this request on behalf of a California resident, as indicated above. You understand that it may be necessary for us to further verify the identity of the California resident and/or the Authorized Agent and you agree to comply with any such requests.