CALIFORNIA CONSUMER PRIVACY ACT REQUEST

Name

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

Yes No

Please note you must be a California resident to request information based on the California Consumer Privacy Act.

Address

Email

Phone Number

Please describe in what capacity or context you have interacted with us to date in which you may have provided personal information to us:

Employee Job Applicant Independent Contractor or Consultant Website User App User Individual Customer (non-entity) Service Provider, Vendor or Supplier Other; please specify

Type of Request:

Language:

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

Yes No

Agent’s Name:

This agent has been authorized in writing to submit this request on my behalf:

Yes No