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Consumer Privacy Notice Form

Consumer Privacy Notice Form



If you are not the Consumer making the request but rather an authorized agent of the Consumer, enter your name below.

Yes No

If you are an authorized agent for the above referenced consumer, we will request a copy of your government issued identification card, and the source of your authority to act on behalf of the consumer (e.g., POA, letters of conservatorship, written instructions, etc.). Additional details will be provided to you regarding what we need to verify you and your request within 10-days of your submission of this form.

Please select all of the following that apply to your request:

Type of Request

1) Request to Know?
This includes categories of personal information we collect, categories of collection sources, purpose for collecting or selling information, categories of third parties we share information with, and specific pieces of information about you. (if applicable)

Yes No

2) Request to Delete Personal Information?
Within 10 days of your submission of this form, we will notify you of what we will need to verify your identity (if applicable).

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