CCPA request form

California Consumer Privacy Act request form

The California Consumer Privacy Act (CCPA) provides California residents with specific rights regarding their personal information. For details, read our California privacy statement.

Note: This form is not secured. Do not include sensitive information such as a social security number, birthdate, account numbers, or other personal information

"*" indicates required fields

This field is for validation purposes and should be left unchanged.

First name*

Last name*

Email*

Phone*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Please tell me what personal information you have collected and retained about/from me.

Please delete the personal information you have collected and retained about/from me.

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