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 days and provide information about how we will process the request. Typically, we will respond to your request within 45 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 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.(Required)

I am.

I am not.

These rights are for California residents only.

Individual Making the Request:(Required)

I am the consumer about whom the request pertains.

I am an agent of the consumer about whom the request pertains.

Note, if you are an agent of the consumer about whom the request pertains, in addition to the information requested about the consumer on the next page, please email us at [email protected] and provide the following information:

1. To verify your authorization to request on behalf of a California resident, please attach a copy of one or more of the following to your email:

- California Secretary of State authorization,
- written permission from the California resident, or
- power of attorney.

2. To verify your identity, please attach copies of the following to your email:

- valid Government Issued ID (not expired), AND
- a Utility Bill, Bank Statement, or similar documentation to verify your name and address.

Type of Request:(Required)

Request to Know Categories of Information Collected

Request to Know Specific Pieces of Information Collected

Request for Deletion of Personal Information

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Email(Required)

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.