Privacy Request Form for California Residents

Please complete the information below.

Are you (or the person for whom you are submitting this request) a California resident?

Are you submitting this request on behalf of yourself?

If you answered No, please provide the following information regarding the person for whom you are submitting this request.

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What type of request are you submitting? (check all that apply)

For responding to requests to know, how would you like to receive the information:

Which of the following categories apply to you (or the person for whom you are submitting this request)? Check all that apply. If none apply, please check the “Other” box below.

By submitting this request, I hereby certify that the information provided by me is accurate and complete, that I am authorized to submit this request, and that I am, or the person for whom I am submitting this request is, a resident of California.