By submitting this Request Form to you, I certify that I am a California resident who wishes to exercise my rights to make a request under the California Consumer Privacy Act (CCPA). I understand that you are required to keep a record of my request for at least 24 months, including any reference number assigned to my request, the request date and nature of the request, the manner in which the request was made, the date and nature of your response, and the basis for the denial of the request if the request is denied in whole or in part.
Requestor's Contact Information
I understand that your response(s) to my request will be in writing and I authorize you to provide your response(s), send verification of receipt of my request, or contact me in connection with my request, using the following contact information and method(s) of delivery:
The nature of my request is as follows, and I understand that I am only permitted to make a verifiable consumer Request to Know or Request to Access regarding my data under the CCPA twice in any 12-month period. (Check appropriate box and provide associated information as applicable).
