Your Name: *

First Name

Last Name

Your Address: *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Your Telephone Number: *

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Requestor Type: I am a *

Consumer

Authorized Agent

Parent/Legal Guardian making a request on behalf of a minor child

Type of Request: *

Know Personal Information Collected or Disclosed

Delete Personal Information

If you are exercising a Right to Know Request, what are you requesting?

Categories of Personal Information

Specific Pieces of Personal Information

Both Categories and Specific Pieces of Personal Information

Please provide the below information about the consumer who is making the request (or if you are an agent, on behalf of whom you are making this request) so that we may use the information to verify the consumer’s identity. *

First Name

Last Name

Consumer's Address: *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Consumer's Telephone Number: *

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