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California Privacy Rights Act (CPRA) Request Form

First Name(Required)

Middle Name

Last Name(Required)

I am or have been in the last 12 months a California resident:(Required)

Yes

No

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email(Required)

Phone(Required)

Please describe in what capacity or context you have interacted with us to date in which you may have provided personal information to us. Check all boxes that apply:

Employee

Job Applicant

Independent Contractor or Consultant

Website User

App User

Individual Customer (non-entity)

Service Provider, Vendor or Supplier

Other

Other; please specify:

Type of request

Request to Know

Categories of personal information collected from or about me since 1/1/2022.
Categories of sources from which the personal information was collected.
Business purpose for which the personal information was used.
Categories of third parties to which the personal information was disclosed since 1/1/2022.

Access Request

Please provide me with the specific pieces of personal information collected from or about me since 1/1/2022.

Request to Correct

Please correct personal information you have collected from me.

Request to Limit Use and Disclosure of Sensitive Personal Information

Please limit your use and/or disclosure of my sensitive personal information to only those purposes expressly prescribed by the California Privacy Rights Act.

Request for Deletion

Please delete all personal information that you have collected from me.

Request to Opt-Out of Sale/Sharing of Personal Information

I do not want my personal information to be sold. Please cease and refrain from selling my personal information.
I do not want my personal information to be shared with a third party for cross-context behavioral advertising purposes. Please cease and refrain from sharing my personal information for such purposes.

Request to Withdraw From Financial Incentive Program

Please enter a short description of the personal information you believe is incorrect, using the box below.

Please enter the correct personal information in box below.

Are you sure you want us to correct the personal information that you have identified?(Required)

Yes

No

Are you sure you want us to permanently delete all your personal information that we have collected from you?(Required)

Yes

No

This request has been submitted through an agent on my behalf:(Required)

Yes

No

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