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CCPA Request Form
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Consumer Details
I am the California consumer to whom the request relates.
I am the authorized representative for the California consumer to whom the request relates.
First Name
Last Name
Email
Phone Number
Request Type:
Access
Deletion
Do Not Sell
Representative Details
Representative's First Name*
Representative's Last Name*
Relationship to Data Subject*
Representative's Email*
Representative's Phone Number
*Field mandatory. Optional fields may expedite our verification process.
Under penalty of perjury, I hereby certify that I am the California consumer whose personal information is the subject of this request.
Under penalty of perjury, I hereby certify that, when submitting this request, I am acting in my capacity as the authorized representative of the California consumer to whom the request relates.
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