CCPA Data Request

First Name (Required)

Last Name (Required)

Phone

Email (Required)

Address(Required)
Street Address
Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country

California Resident(Required)

Yes

Request for Information

Categories of personal information the company collected about you

Categories of sources from which the personal information was collected

Categories of personal information about you that the company sold or disclosed for a business purpose

Categories of third parties to whom the personal information was sold or disclosed

The business purpose for collecting the personal information

Request to Access

The personal information collected about you in the preceding 12 months

Request to Delete

The personal information that the company collected directly from you

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