Data Subject Access Request Form

Your Full Legal Name:
Your own name, even if you are making the request on behalf of someone else who you are authorized to represent. If you are representing someone else, you must have the legal authority to act on their behalf.

REQUEST TYPE:

Identify the type of request you are submitting. If you have multiple request types, please submit separate forms for each request type.

Detailed description of the personal data that is the subject of this request, and the action you request to be taken with respect to your personal data.

To the best of your ability, please describe the data you are referring to in this request. Be as specific as possible.

SWORN STATEMENTS

Please read the following statements, and check the boxes to confirm that you agree.

SIGNATURE

By typing your full name above, you are providing us with your digital signature, which is as legally binding as your physical signature. Please note that your signature must exactly match the first and last names that you entered at the top of this web form in order for your submission to be successful.

Your Full Legal Name:
Your own name, even if you are making the request on behalf of someone else who you are authorized to represent. If you are representing someone else, you must have the legal authority to act on their behalf.

I am acting on behalf of...

SUBJECT'S INFORMATION
Information of the subject of the request, which may or may not be different from the person completing this form. I.E. The person that the data you are requesting or requesting be deleted is about.

Subject's Full Legal Name:

REQUEST TYPE:

Identify the type of request you are submitting. If you have multiple request types, please submit separate forms for each request type.

Detailed description of the personal data that is the subject of this request, and the action you request to be taken with respect to your personal data.

To the best of your ability, please describe the data you are referring to in this request. Be as specific as possible.

SWORN STATEMENTS

Please read the following statements, and check the boxes to confirm that you agree.

SIGNATURE

By typing your full name above, you are providing us with your digital signature, which is as legally binding as your physical signature. Please note that your signature must exactly match the first and last names that you entered at the top of this web form in order for your submission to be successful.