Residents of other states are not entitled to use the following form.
Verifiable Consumer Request:
In order to process your request for Data Deletion, Portability, and/or Information Disclosure, please complete this form with your current and accurate information to make a verifiable consumer request. This information must match what we have in our system in order to be validated for your protection, with the validity determined by us in our reasonable, good faith discretion. All requests must first be authenticated before proceeding. Information submitted through this form will be used only to process your request, but must be complete and valid.
By submitting an Information Disclose Request through this form electronically, you will receive only the categories of data we have for you. In order to receive the specific data we have for you, you must print, sign, scan, and email this form to email@example.com At least three data points must match the data we have on file to receive this specific information.
*denotes required fields