Consumer Request Form

Please complete the information below. When you have completed the required information, submit the form by clicking “submit” at the bottom.

After receiving this form, we will be in touch with you to verify your identity and follow up on your request in compliance with applicable law.

1. Complete the following information of the person whose information is the subject of this request

First Name

This field is required.

Last Name

This field is required.

Phone Number

This field is required. Make sure this is a valid phone number.

Email Address

This field is required. Make sure this is a valid email address.

2. Request Type [check all that apply]

I request access to specific pieces of personal information you have about me (to better understand your request, please describe in text box below)

I request access to categories of personal information that you have collected about me (to better understand your request, please describe in text box below)

Delete specific pieces of my information (describe in text box below)

Opt-out of all sales of my personal information

3. Additional comments

Please provide additional detail in the text box below