Data Rights Request Form

Please Review for Accuracy Before Submission

Requestor Information

Full Name:

Email Address:

Phone Number:

Date of Birth:

Street Address:

City:

State:

Zip / Postal Code:

Verification of Identity- Please Provide proof of your identity (e.g., copy of id, passport, or utility bill):

If you are making this request on behalf of someone else, please provide proof of authorization:

Please specify the type of data rights request you are making:

Description of Request:

Purpose of Request:

Additional Information:

By submitting this request, I acknowledge and agree to the Privacy Policy. I confirm that I have the right to make this request, whether it concerns the processing of my personal data or if I have obtained authorization from the data subject whose data is included in this request. I also verify the accuracy and correctness of the information provided in my request. I understand that my request, along with its contained data, will be processed to address my inquiry.

334-793-1896