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Submit a Verified Consumer Request Pursuant to CCPA

Verified Consumer Request Form

To process Your Verified Consumer Request, we need some basic information from you. We will only use personal information provided to verify your identity or authority to make the request, to locate the information within our systems and respond to your request. We cannot respond to your request if we cannot verify your identity or authority to make the request and confirm that the personal information relates to you. For more information, please go to CA Disclosures and Privacy Policy.

  • SECTION 1: Consumer


    * Required Fields





    SECTION 2: Requestor


    SECTION 3: Nature of Request



    The e-mail address you provided in Section 1 will be used for correspondence relating to this request. If you made a Right to Know – Specific Pieces of Information request, you can opt to receive the information by mail instead. If you elect to receive the Right to Know – Specific Pieces of Information by mail please check the box and provide your mailing address below.


    I acknowledge that I am a California resident and the person making the request noted above, under the California Consumer Privacy Act. I further acknowledge that I am making this request in good faith on behalf of myself or as an Authorized Agent acting on behalf of the Consumer that is the subject of this Request.

 
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