Consumer Request Form

First Name:

Last Name:

Email:

Address:

City:

State:

Postal Code:

I am a (check the box(es) as applicable):
Prospective CustomerCurrent CustomerFormer CustomerFormer EmployeeCurrent EmployeeVendor / SubcontractorOther (Please specify in space below)

*Please note that all of this information is requested in order for us to confirm your identify and process your request.

Please identify your request (choose one):
Disclosure of personal information collected / disclosedDeletion of personal informationOpt-out of selling personal informationLimit use and disclosure of sensitive personal informationCorrection of personal information

What time period would you like your request to cover (choose one)?
The preceding twelve (12) monthsAny personal information collected or processed after January 1, 2022

We will ask for some additional verification to comply with this request in order to protect your privacy. We may also need to request additional information from you to verify your identity and determine the propriety of your request, before we provide a substantive response. We cannot respond to your request or provide you with personal information if we cannot verify your identity or authority to make the request and confirm the personal information relates to you.

We endeavor to respond to a verifiable consumer request for access, deletion or correction within forty-five (45) days of its receipt. If we require more time (up to 90 days), we will inform you of the reason and extension period in writing. The response we provide will also explain the reasons we cannot comply with a request, if applicable. We will respond to an appropriate request to opt-out or limit use within fifteen (15) days of receipt.

Any disclosures we provide will only cover the time period requested above. For data portability requests, we will select a format to provide your personal information that is readily useable and should allow you to transmit the information from one entity to another entity without hindrance.

You may only make a verifiable consumer request for access or data portability twice within a 12-month period. These requests are free, though we reserve the right to implement a reasonable fee for excessive or complex requests you may submit.

Making a verifiable consumer request does not require you to create an account with us. We will only use personal information provided in this request form to verify your identity or authority to make the request.