Right to Know and Delete Form

 

By using this form, you may elect to exercise your privacy rights as a California resident.

You may also submit a request to exercise these rights by calling us at 1-855-275-5787.

 

Instructions: Please complete the required fields below.  Information collected on this form will be used and retained only to process your request.

 

 

 

 

State of Residence

 

CA - I certify that I am a California resident

Other States - Sorry, this request is not yet available in your jurisdiction and submitted forms will not be processed.

 

 

 

 

 

How would you like us to contact you in regards to this request?

 

Email

Phone

 

If you provided an email address to us as part of submitting this request, you consent to receive electronic communications (email) from us regarding your request.

 

I am a:

 

Customer

Marketing Recipient

Authorized Agent submitting a request on behalf of another

Other

 

Please select the type of request you wish to make:

 

Request to know about personal information collected

Request deletion of personal information

 

Please let us know what information you are requesting:

 

The categories of personal information we have collected about you.

 

The categories of sources from which we have collected persona information about you.

 

The purpose of which we collected personal information about you.

 

The categories of third parties with whom we have shared personal information about you.

 

  Specific pieces of personal information that we have collected about you relating to:

 

 

We will comply with your request to know your personal information unless the personal information is outside the scope of California's privacy laws, is otherwise exempt from disclosure, or we cannot confirm your identity.  Note that California law prohibits us from disclosing certain sensitive types of information including financial account numbers, an account password, or security questions and answers.

 

Please confirm your identity.

 

We will contact you by email or phone to confirm your identity.  If you do not have a web-access account with us, we will contact you by e-mail or phone to collect the necessary information.

 

If we are unable to verify your identity as part of your request, we may be prohibited from fulfilling your request.

 

Delivery of Specific Pieces of Information

 

If you are requesting to know the specific piece of information we have collected about you, please let us know how you would like to receive that information:

 

Paper

Electronic

 

Submit a request on behalf of someone else

 

If you are requesting personal information on behalf of someone else, we will contact you and you'll be expected to provide an authorization letter.  We may require the person to verify their identity with us directly and to verify that you have been authorized to submit a request on their behalf.  If we verify that you are authorized to know the requested personal information, we will contact you to collect additional information.

 

Declaration under penalty of perjury

 

By submitting this form, you agree, on penalty of perjury or other criminal offense under applicable law, that either you are the individual about whom this request for personal information relates, or that you are authorized by that individual to make this request on their behalf.