Consumer Access Request Form

Name (required)

Date of Birth

Telephone Number (required)

Address (required)

City (required)

State (required)
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Zip Code (required)

Email (required)

Specific pieces of personal information, collected or shared with third parties and for what business/commercial purpose.

Request to delete data.

We do not sell personal information that we have collected from consumers to any third parties. By completing this form, you are making a Consumer Access request under California Consumer Privacy Act for personal information collected, held and disclosed about you that you are entitled to receive. On this date Jan 24 2020, I affirm that I am the consumer, or authorized by the consumer to act on their behalf. I understand that misrepresentation may be subject to legal action.