Privacy Request

IMPORTANT: Form must be completed in its entirety prior to submission.

Form submissions with inaccurate or missing information may not be processed.

Are You a California Resident?

What Request Would You Like To Make?

First Name

Last Name

Email Address

Phone Number

By click Submit Request, I hereby certify under penalty of perjury that I am the consumer whose personal information is the subject of this request. If you are not the consumer but are the consumer’s authorized agent, check the box below and enter your information.

I am acting as an authorized agent for the person named above

Authorized Agent's First Name

Authorized Agent's Last Name

Authorized Agent's Email Address

Authorized Agent's Phone Number

If you are an authorized agent acting on the behalf of a consumer in making this request, you must submit proof that the consumer has provided you written permission to submit this request, either in the form of a power of attorney or a written authorization signed by the consumer along with proof of the consumer’s identity. If you are an authorized agent, please check the box below.

I hereby certify under penalty of perjury that I am the authorized agent for the consumer whose personal information is the subject of this request.

Penalty Of Perjury Waiver

I declare under penalty of perjury I am the person identified above and the information I provide to this Privacy Portal is true and accurate. *