CALIFORNIA CONSUMER PRIVACY ACT REQUEST FORM

    CALIFORNIA CONSUMER PRIVACY ACT REQUEST FORM

    REQUESTER INFORMATION

    SPECIFY TYPE OF REQUEST – CHECK ALL THAT APPLY

    Request Delete

    Request for access to all personal information collected on meRequest for access to categories of personal informationRequest to correct personal information

    DECLARATION

    BY CHECKING THE BOX BELOW, I HEREBY CERTIFY THAT THE INFORMATION ENTERED INTO THIS FORM IS COMPLETE, ACCURATE AND UP-TO-DATE, AND THAT I AM THE CONSUMER WHO IS THE SUBJECT OF THE REQUEST OR HAVE BEEN AUTHORIZED BY THAT CONSUMER TO ACT ON HIS/HER BEHALF, AS INDICATED ABOVE.  I UNDERSTAND THAT IT MAY BE NECESSARY FOR YOU TO VERIFY THE IDENTITY OF THE CONSUMER AND/OR AUTHORIZED AGENT FOR THIS REQUEST, AND ADDITIONAL INFORMATION MAY BE REQUESTED FOR THIS PURPOSE

    I Consent