Right to Know Request Form

Under the California Consumer Privacy Act (“CCPA”), you have the right to request that we provide you with certain information about the personal information we collect, use, and disclose, about you as well as the categories and specific pieces of information that we have collected about you in the past 12 months. Only you (or an authorized agent) may make a request to access your personal information. Please note that these requests are subject to verification as described in more detail below.

Consumers in a household also may request to know aggregate household personal information by submitting a joint request. If all consumers in a household jointly request household personal information (aggregate or specific pieces of personal information), and we can individually verify all the members of the household, then we will respond to the request.

Please also note that we do not collect the personal information of minors under the age of [16] and we do not and will not sell your personal information.

As noted in our CCPA Privacy Policy, the CCPA does not apply to certain information we collect such as certain personal information covered by or collected under industry-specific privacy laws including, but not limited to, the Health Insurance Portability and Accountability Act of 1996, the California Confidentiality of Medical Information Act, the Fair Credit Reporting Act, the Gramm-Leach-Bliley Act, the California Financial Information Privacy Act, and the Driver's Privacy Protection Act of 1994. There are additional exemptions that apply to certain personal information we collect from job applicants, employees, etc., and from transactions with other entities. Please visit our CCPA Privacy Policy for more information regarding your CCPA rights.

If you prefer to submit a request via an alternative method, you may submit a request by calling our Toll-Free Number at (800) 865-4092.

Request to Know Personal Information Collected, Used, and/or Disclosed *

Yes

Part 1: Requester's Identity

Name of Requester *

Address *

E-mail Address *

State of Residence *

Date of Request *

Year

Month

Day

Select one of the following request types

Name of consumer on whose behalf information is being requested:

Name of Consumer 1 in household:

Name of Consumer 2 in household:

Name of Consumer 3 in household:

Name of Consumer 4 in household:

Additional household members:

Part 2: Requested Information

Select all of the types of personal information you would like to request to know:

The categories of personal information we have collected about you.

The categories of personal information that we disclosed about you for a business or commercial purpose.

The specific pieces of personal information we have collected about you.

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

Our business or commercial purpose for collecting your personal information.

Our business or commercial purpose for disclosing the category of personal information about you.

The categories of third parties to whom your personal information was disclosed for a business or commercial purpose, and which category of personal information was disclosed to that third party.

Aggregate household personal information.

Specific pieces of household personal information

Note that there is certain information that we will not disclose to you. Please see our CCPA privacy policy for additional information.

Part 1: Requester's Identity

Part 2: Requested Information

Part 3: Submit Request