CCPA Consumer Request Form

First Name

Last Name

Address

City

State

ZIP

Phone Number

Email

This request is on behalf of another individual who is a California resident. I am an authorized agent to submit this request.

First Name

Last Name

Address

City

State

ZIP

Select one or more of the following requests:

Know what categories of personal information we collected about the Consumer, the categories of sources from which the personal information was collected, the business or commercial purpose for collecting, the personal information, the categories of personal information we disclosed for a business purpose, and for each category identified, the categories of third parties to whom we disclosed that particular category of personal information. Access specific pieces of personal information that we collected and maintain about the Consumer. Delete all personal information we have collected about the Consumer. Correct inaccurate personal information we maintain about the Consumer. (Please access your account online or contact Customer Care at 1-800-501-6535 to update any account information.)

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