Privacy Request Form Domain
Privacy Request Form
I am...
*
Select One
A consumer
An employee/job applicant
An authorized agent of a consumer
An authorized agent of an employee/job applicant
Client Information
Name of Consumer/Employee/Job Applicant
*
First Name
Last Name
Name of Authorized Agent
*
First Name
Last Name
Email Address
*
example@example.com
State of Residence
*
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Select Request Type
*
Select One
Access
Deletion
Opt-Out of Selling or Sharing of Personal Information
Correction
Limit use and disclosure of sensitive information
Appeal
Are you a robot?
*
Submit
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