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CCPA/CPRA Personal Information Request Form

As of January 1, 2020, California law provides residents of California certain rights in regard to how their personal information is used or shared with third-parties or affiliated companies. As of January 2023, California privacy laws were further expanded to include provisions that allow consumers to direct businesses to refrain from “sharing” personal information for any reason whereas previously, consumers could only restrict the “sale” of personal data. In addition, the CCPA/CPRA restricts a business’s ability to correct privacy violations before being penalized. Finally, the CPRA grants enforcement power to a newly created state agency, the Consumer Privacy Protection Agency (CPPA). This form is designed to allow you to exercise your rights under the CCPA/CPRA. Please review our Consumer Privacy Policy for a complete discussion of those rights.

Request Information

First Name

Last Name

Phone Number

Address

City

State

Zip Code

I am requesting a right under the CCPA/CPRA...

I am...

Select all that apply:

I want to receive my personal information.

I want to correct my personal information.

I want to delete my personal information.

I want to opt out of any sale of my personal information.

I want to opt out of any sharing of my personal information.

I am requesting access to information about automated decision making.

I want to opt out of automated decision-making technology.

How would you like us to respond to you?

Free Text

If you are requesting information on behalf of someone else, please provide their information below. If you are not, leave the following blank.

Represented Party First Name

Represented Party Last Name

Represented Party Phone Number

Represented Party Email

Represented Party Address

City

State

Zip Code

Opt-In

By checking, I agree to being contacted through the information provided above.