California Consumer Privacy Act Request

If you are California resident, you can use this form to submit requests under the California Consumer
Privacy Act (CCPA). We reserve the right to refuse requests, in accordance with the Act, if we are not
able to identify your identity or verify that you have the authority to act on behalf of another person.

We may contact you for additional information to verify your request and keep records of your request.

Request Form

Consumer's Full Name:
Consumer's E-mail Address:
Consumer's State of Residence:
Are you making this request on behalf of another person?*

* If you are making this request on behalf of another person, we will contact you to obtain a copy of their signed agent authorization form.
Requester's Full Name:
Requester's E-mail Address:
Requester's State of Residence:
Which request(s) would you like to make?
Request to know the categories of information collected, used, disclosed, and/or sold about the consumer
Request to obtain specific pieces of personal information collected about the consumer
Request to delete personal information collected about the consumer
Request to opt out of the sale of personal information about the consumer