CCPA Declaration Form

The following CCPA requests require you to submit a signed declaration under penalty of perjury that you are the consumer whose personal information is the subject of this request.

* Right to Know - Specific pieces of Personal Information

* Deletion Request

provided below so that we may fulfill your request made pursuant to CCPA.

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I. Choose Request Type:

• CCPA Request Type *
  Right to Know Deletion Request

II. Requestor/Declarant Details:

I acknowledge that I am a California resident and the person making the request noted above, under the California Consumer Privacy Act. I acknowledge that I am making this request in good faith on behalf of myself.

I CERTIFY AND DECLARE UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF CALIFORNIA THAT THE FOREGOING INFORMATION IS TRUE AND CORRECT AND THAT I AM THE CONSUMER WHOSE PERSONAL INFORMATION IS THE SUBJECT OF THE REQUEST.

Please provide your verification, as requested below, your name and today's date (CCPA Date) in the spaces provided below.

First Name *
Last Name *
CCPA Date *
Email *

For verification, please enter your Initials and your Postal/Zip Code in the CCPA Confirmation Code field:

CCPA Confirmation Code *

Send CCPA Request