California Consumer Privacy Act (CCPA) Request Form

If you are a California resident, you can use this form to submit a request pursuant to the California Consumer Protection Act (CCPA). We do not sell personal information. Learn more about our privacy practices in our Privacy policy.

* required fields

Declaration of identity

Are you the consumer? *

Yes, I am the consumer that is the subject of this request.

No, I am an authorized agent acting on behalf of the consumer that is the subject of this request.

Consumer's information

California residency *

I confirm that I am a California resident, as defined in Section 17014 of Title 18 of the California Code of Regulations.

First name *

Last name *

Email address *

If you have an account, this is the email address associated with your account. If you don't have an account, provide your email address.

Authorized agent's information

First name *

Last name *

Business entity name (if applicable)

Secretary of State Registration Number (if applicable)

Email address *

Telephone number *

Basis of authority to submit the request on behalf of the consumer *

If other, please explain *

Request information

Request type *

Request to know the categories of your personal information and/or the business or commercial purpose for collecting or selling your personal information.

Request to know the specific pieces of personal information that we have collected about you.

Request to delete the personal information about you that we have collected from you.

Information you want to be disclosed *

The categories of personal information we have collected about you in the preceding 12 months.

The categories of sources from which your personal information was collected.

The business or commercial purpose for which we collected or sold your personal information.

The categories of third parties with whom we share your personal information.

The categories of personal information that we sold in the preceding 12 months, and for each category identified, the categories of third parties to whom we sold that particular category of personal information.

The categories of personal information that we disclosed for a business purpose in the preceding 12 months, and for each category identified, the categories of third parties to whom we disclosed that particular category of personal information.

In order to process the request, it may be necessary to verify the identity of the consumer. If the request is made by an authorized agent, it may be necessary to verify the identity of the authorized agent, and the authority of the agent to act on behalf of the consumer. After submitting the request, you will receive a confirmation email. Depending on the request, you may also receive instructions to verify the identity of the consumer, the identity of the authorized agent and the authority of the agent to act on behalf of the consumer. Additional information or documentation may be requested.

I attest, under penalty of perjury, that the information in this declaration is true, accurate and complete and that it is my intention that this electronic request to exercise a data right under the California Consumer Privacy Act shall carry the same force and effect as if I had manually signed this request. *