CCPA Data Subject Request Form

Welcome to the California Privacy Request Form

You can use this form to submit a request regarding your personal information if you reside in California.

Please complete this form and we will respond as soon as reasonably possible.

For more details and information about how we use and protect your personal information and process your request, please visit our Privacy Policy and our Notice to California Residents.

Thank you!

I am submitting this information on behalf of:

I am a (an)

Select the Right You Want to Exercise:

First Name

Enter the first name of the data subject

Last Name

Enter the last name of the data subject

Enter email for correspondence with the data request.

Phone Number

Address

Address Line 2

Address line 2

City

State

Zip Code

Additional information about your request

Enter any additional information in this section that will help us process your request. Please refrain from entering any personal information.

Acknowledgement

Acknowledgment

By submitting this form I confirm I am a resident of California and that the information I have provided is accurate.