Information Access Request

Please fill out the form below to submit your information access request. We will acknowledge receipt of your request within 10 days. However, full processing of your request may take up to 45 days from the date of submission. Your request may be subject to verification of your identity prior to completion. You may also submit your request by calling 866.423.1818 and speaking with our Consumer Privacy Coordinator.

Name *

First

Last

Address *

Apt/Suite

Email *

Confirm Email

City *

State *

Zip *

Mobile Phone

LandLine

Authorized Agent Name *

If you are an authorized agent submitting an information request on behalf of a consumer, you must complete this section and the fields below. A representative will contact you to obtain the signed legal document that authorizes you to act on the consumer's behalf. If you are a consumer making your own request, you may ignore these sections.

Email *

Confirm Email

Authorized Agent Address

Authorized Agent City

Authorized Agent State / Region

Authorized Agent Country

Jurisdiction of Agency Authority

Please list the applicable law or document that authorizes you to act as agent for the consumer. E.g., CCPA, Florida Statute ch. 709, executed Power of Attorney, etc.)

Single Line Text

Message