California Consumer Privacy Act (CCPA) Request Form

If you wish to submit (1) a request to know categories of information collected, (2) a request to know specific pieces of information collected or (3) a request for deletion of personal information, please complete the form below. Please note that you must submit a separate request for each type of request that you wish to make.

Upon receiving your request, we will confirm receipt within 10 business days and provide information about how we will process the request. Typically, we will respond to your request within 45 calendar days from the day we receive your request. In certain circumstances, we may need additional time to respond to your request. If we do, we will notify you of the need for an extension, but, in any event, we will respond to your request within 90 calendar days from the day we receive your request.

I affirm that I am a California resident or an authorized representative of a California resident as defined by Section 17014 of Title 18 of the California Code of Regulations.

I am.
I am not.
These rights are for California residents only.

Individual Making the Request:

I am the consumer about whom the request pertains.
I am an agent of the consumer about whom the request pertains.
I am a business contact whose personal information may have been collected through my business interactions with your company

Type of Request:

Request to Know Categories of Information Collected
Request to Know Specific Pieces of Information Collected
Request for Deletion of Personal Information
Request to correct inaccurate personal information

Consumer Information:

First Name
Last Name
Address
City
State
Zip Code

Contact Information:

Phone Number
Email Address

By submitting this request, I declare under penalty of perjury under the laws of the State of California that I am, or am the proper agent of, the person about whom this request pertains.

Agent Information:

Name
Email Address
Phone Number

By submitting this request, I declare under penalty of perjury under the laws of the State of California that I am, or am the proper agent of, the person about whom this request pertains.

Vendor/company Information:

Name
Business Name
Phone Number
Email Address

By submitting this request, I declare under penalty of perjury under the laws of the State of California that I am, or am the proper agent of, the person about whom this request pertains.

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