California Residents Opt-Out Request Form

Please use this form if you are a California Resident and wish exercise your rights under the California Consumer Protection Act (CCPA) to know, opt-out, or delete your information.

Request Type Being Made

First Name

Last Name

Alternative Names

If you have changed your name or known by other names, please indicate those names here.

Are you requesting on behalf of someone else?

Requestor's Full Name

If you are submitting on behalf of someone else, please include your name here.

Requestor's Contact Information

If you are submitting on behalf of someone else, please include your contact information (e.g., email address, telephone number, or mailing address) here.

Address Line 1

Address Line 2

City

State

Zip Code

Telephone Number

Email Address(es)

Please indicate if you submitted your information through any of the listed topics below.

Select all of the options that you think apply to your request.

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