AccountID
Name
E-mail Address
Mailing Address
Street
Apt / Suite / Other
City
Zip Code
State
Please select...
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Puerto Rico
Virgin Island
Northern Mariana Islands
Guam
American Samoa
Palau
Address of residence (if different from mailing address)
Street
Apt / Suite / Other
City
Zip Code
State
Please select...
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Puerto Rico
Virgin Island
Northern Mariana Islands
Guam
American Samoa
Palau
Phone Number (e.g. 111-222-3333)
Member ID
Please select one option
Request to Know
Request to Delete
Request to Opt Out
Request to Know
Please state the nature of your request. You may select more than one.
I wish to request the categories of personal information that you have collected about me.
I wish to request the categories of sources of personal information that you have collected about me.
I wish to request the business or commercial purposes for collecting or sharing information about me.
I wish to request the categories of personal information that you share for a business or commercial purpose.
I wish to request the categories of third parties with which you share information about me for a business or commercial purpose.
I wish to request specific pieces of information that you have collected about me.
Please specify in the below text box which information you are requesting.
Please also upload a signed declaration under penalty of perjury that you are the consumer whose personal information is the subject of this request and are 18 years old or older OR that you are 18 years old or older and have the authority to make this request on behalf of the consumer whose personal information is the subject of this request.
Request to Delete
Please state the nature of your request.
I wish to request the deletion of all personal information that you have collected about me.
I wish to request the deletion of certain personal information that you have collected about me.
Please specify in the text box below which information you are requesting that we delete.
Once you submit your request, you will be asked to confirm your request to delete your information.
Request to Opt Out
Please state the nature of your request.
I wish to opt out of the sale of all personal information that you have collected about me.
Please specify in the text box below which categories of information you are requesting that we not sell.