CCPA Request Form

CALIFORNIA CONSUMER PRIVACY ACT REQUEST FORM

First Name*

Last Name*

Email Address*

Street Address*

City*

State*

Zip Code*

Country*

Phone Number*

Are you making this request on your own behalf?

Yes (Skip other person questions below)

Other person's Full Name

Other person's Email Address

Other person's Full Address

Other person's Phone Number

What are you requesting?

To know the categories of personal information collected, processed and/or shared within the previous 12 months.

To delete my personal information.

To access the specific pieces of personal information we have collected, processed and/or shared within the previous 12 months.