California Residents Data Rights Request Form

Person about whom we collected Personal Information: Person about whom we collected Personal Information: New Field

First Name

Last Name

Address

Person Making the Request: Person Making the Request: New Field

Same Same Same as above

Name

Last Name

Address

Requestor Contact Information:* Requestor Contact Information:* Email Address Phone Number

Email

Phone Number

I Request that You:* I Request that You:* Disclose information about the collection and use of personal information in the last 12 months Delete some or all of the personal information collected

Specific Information Requested (if not specified, we will provide a full report)

Specific Information to Delete (if not specified, we will delete all information, with certain exceptions):