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Consumer Data Request Form

Residents of California may use this form to submit requests to exercise their legal rights for access or deletion of personal information. While not all fields are required, please be advised that we can only search for your information using the details that you provide; if you decline to provide information, our search may be incomplete.

If you are completing this request on behalf of another person, please fill in the consumer’s information and add your information in the space provided.

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Consumer Name Required Field ^*

Consumer Email Address Required Field ^*

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Consumer Mobile Phone Number

Consumer Mailing Address

Consumer Permanent Address Required Field ^*

Other Identifying Details We Should Search (IP Addresses, Device IDs, etc)

Please describe the nature of Consumer’s relationship with Company Required Field ^*

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Customer

Employee

Former Employee

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Nature of Request

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Tell me the specific pieces of personal information you have collected about me

Delete personal information you have collected from me

Correct inaccurate personal information you have collected from me

Only use my sensitive personal information for limited purposes, such as providing me with the services I requested

Stop selling or sharing my personal information

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Are you completing this request on behalf of another individual? Required Field ^*

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Yes, I am the legal parent/guardian and the Consumer is under 18.

Yes, I have legal authority to act on behalf of the Consumer.

Yes, the Consumer has authorized me to act on his/her behalf.

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If yes, please provide YOUR name, email address and telephone number:

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* = required field

For the protection of our customers, it may be necessary for us to request additional details, including a government-issued photo ID, to confirm your identity before we act on your request. We will contact you by email if this is necessary. We will not use personal information submitted for the purpose of a Consumer Data Request for any purpose other than to effectuate your request.

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CAUTION - Before you proceed, please note: By clicking “accept” you agree that our review of the information contained in your e-mail and any attachments will not create an attorney-client relationship, and will not prevent any lawyer in our firm from representing a party in any matter where that information is relevant, even if you submitted the information in good faith to retain us.