California Consumer Privacy Act-Form

CCPA Form

California Consumer Privacy Act (CCPA) Verifiable Consumer Request Form

For more details, please see the Privacy Notice and Disclosure for California Residents here.

All fields are mandatory. Please fill in sufficient information, so that your request can be processed successfully. 

I. Requestor Category (select one)

Select Request Type

II. Request Type (check all that apply)

Select Request Type

(Signed Declaration is required for this option)

(Signed Declaration is required for this option)

(Signed Declaration is required for this option)

III. Please provide the following information to help us process your request:

IV. Response Type

Select Preferred Response Type
Email

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