CCPA Consumer Rights Request Form

If you are a California resident, you have certain rights under the California Consumer Privacy Act (“CCPA”). Upon submission of a verifiable consumer request, you have the right to request that a business that collects your personal information provide disclosures about or access to, in a portable and (if technically feasible) readily usable form, the specific pieces and categories of personal information that the business has collected about you in the past twelve (12) months (from the date of the business’s receipt of the request); the categories of sources for that information; the business or commercial purposes for collecting the information; and the categories of third parties with which the information was shared. California residents also have the right to submit a request for deletion of their personal information under certain circumstances.

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  • If you are an authorized agent of a California resident and are making this request on his or her behalf, you will be required to provide a copy of the California resident’s written authorization (for example a power of attorney) showing that you have been granted the authority to submit a consumer rights request on behalf of the California resident. You will be contacted at either the email address or mailing address you provided above, in order to request a copy of this document for verification purposes. To the extent that the written authorization provided to us is insufficient, we will contact you for further verification at the contact information you provided above. We may additionally contact the California resident in order to verify his or her identity, and to confirm your authority to make a consumer rights request on his or her behalf, prior to responding directly to you.

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