CCPA Declaration Form

The following CCPA requests require you to submit a signed declaration under penalty of perjury that you are the consumer whose personal information is the subject of this request.

  • Right to Know – Specific Pieces of Personal Information
  • Deletion Request

Please complete the below declaration as required to send to us via email or download a pdf form to mail at the applicable address provided so that we may fulfill your request made pursuant to CCPA.

Choose Request Type:

Requestor/Declarant Details:

I acknowledge that I am a California resident and the person making the request noted above, under the California Consumer Privacy Act. I acknowledge that I am making this request in good faith on behalf of myself.

I CERTIFY AND DECLARE UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF CALIFORNIA THAT THE FOREGOING INFORMATION IS TRUE AND CORRECT AND THAT I AM THE CONSUMER WHOSE PERSONAL INFORMATION IS THE SUBJECT OF THE REQUEST.