CCPA Consumer Request Form

The California Consumer Privacy Act of 2018 (“CCPA”) provides California residents with specific rights regarding their personal information. As a California resident, you may exercise these rights by completing the below form. Note that we may ask for additional information or documents to verify your identity prior to processing your request. Please visit our Privacy Policy and CCPA Notice to learn more about how we collect, handle, use, and protect your personal information.

We reserve the right to refuse requests for various reasons, including: (a) to the extent permitted by law; (b) if we are unable to verify your identity; or (c) if we cannot verify your authority to act on behalf of another person.

Name

First Last

Address

City State / Province / Region ZIP / Postal Code Country

Please Select Who the Request Is Being Made For:

Myself

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

Authorized Agent?

Check if you are completing this form as an Authorized Agent

Consumer Name

First Last

Consumer Email

Consumer Address

City State / Province / Region ZIP / Postal Code Country

Please specify your request. For more information on the below, please visit our CCPA Notice.

Click here to visit the CCPA Privacy Policy

Access Request

Data Portability Request

Deletion Request

Consent(Required)

I Accept(Required)

By checking “I Accept”, 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.

Comments

This field is for validation purposes and should be left unchanged.

California Authorized Agent Designation Form

The CCPA allows you to designate an Authorized Agent to act on your behalf, including to submit requests. Please fill out the below form:

Consumer Information

First Name Last Name

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Authorized Agent Information

First Name Last name

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Deliver Information Requested by Agent:

to me, the Consumer

to my Authorized Agent

Allow My Authorized Agent to Make (select all that apply):

Access Requests

Deletion Requests

Portability Requests

Consumer Authorization
By signing below, you give your full authorization for the above-mentioned individual to be your Authorized Agent, as permitted under the CCPA.

Signature

Date
MM slash DD slash YYYY

Phone
This field is for validation purposes and should be left unchanged.