Consumer Rights Request Form Select all that apply: Request for disclosure (tell me about my data) Request for correction (correct my data) Request for access (give me my data) Request for deletion (delete my data) If you are an authorized agent and are making this request on behalf of a principal, you will be required to provide a copy of the principal’s written authorization (for example a power of attorney) showing that you have been granted the authority to submit a consumer rights request on behalf of the principal. You will be contacted at either the email address or mailing address you provide below, in order to request a copy of this document for verification purposes. To the extent that the written authorization provided to us is insufficient, we will contact you for further verification at the contact information you provide below. We may additionally contact the principal in order to verify his or her identity, and to confirm your authority to make a consumer rights request on his or her behalf, prior to responding directly to you. Additional information needed to verify your identity for request processing First name Last name Address 1 Address 2 City State Select state Outside US 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 Postal Code Contact Number Your Email Amount of Recent Purchase Date of Purchase Today's Date Other Information Please indicate how you would like to receive the information requested above by checking one of the following boxes. By Mail By Email Send
