Privacy Request Form

CONSUMER PRIVACY REQUEST FORM

You or your authorized agents, may use this form to submit privacy rights requests. While not all fields are required, please be advised that we can only search for your information using the details that you provide; if you decline to provide information, our search may be incomplete. If you are completing this request on behalf of another person, please fill in the consumer’s information and add your information in the space provided.

*Consumer Name:

*Consumer Email Address:

*Consumer Mailing Address:

*Consumer Mobile Phone Number:

Preferred method of Contact: [optional]

Other Identifying Details We Should Search (IP Addresses, Device IDs, etc.): [optional]

*Please describe the nature of consumer’s relationship with us:

CustomerProspective CustomerJob Applicant, Employee, Independent Contractor, Officer, or Director

Are you completing this request on behalf of another individual?

YesNo

*Nature of Request (i.e., what would you like us to do?):

Tell me the specific pieces of personal information you have collected, processed, or disclosed about me in the last 12 months.Tell me the specific pieces of personal information you have collected, processed, or disclosed about me since January 1, 2022.Tell me the types of personal information you have collected, processed, or disclosed about me within the last 12 months.Tell me the types of personal information you have collected, processed, or disclosed about me since January 1, 2022.Correct inaccurate personal information you have about me.Delete personal information you have about me.

For the protection of our customers, it may be necessary for us to request additional information to confirm your identity or authorization to act for another consumer (if applicable) before we act on your request. We will contact you if this is necessary.

 
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