California Consumer Personal Data Request Form

    If you are a California resident, under the California Consumer Privacy Act (CCPA), you may request to know and request to delete personal and/or household information.

    If you are not the Consumer making the request but rather an authorized agent of the Consumer, please state your full name:

    References to "you" or "your" mean Consumer, not the Consumer’s authorized agent.

    *You authorize us to contact the Consumer and/or the Consumer’s authorized agent (if applicable) for identity verification purposes in accordance with our legal obligations.

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

    Type of Request:

    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.