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Submit a CCPA request

Verified Consumer Request Form

To process Your Verified Consumer Request, we need some basic information from You. We will only use personal information provided to verify Your identity or authority to make the request, to locate the information within our systems and respond to Your request. We cannot respond to Your request if we cannot verify Your identity or authority to make the request and confirm that the personal information relates to You.

For more information, please go to Privacy Notice and Disclosure for California Residents.

SECTION 1: Consumer

Note this address will also be used for correspondence relating to this request

* Please provide at least one of the following to assist us in locating and verifying your account:

SECTION 2. Are you the Consumer who is the subject of this Request?

SECTION 3: Details of Authorized Agent

If this request is on the behalf of the Consumer, upload either a copy of a power of attorney provided by the Consumer pursuant to Probate Code sections 4121 to 4130 or proof of signed permission along with a copy of the Authorized Agent’s ID. If a power of attorney is not provided, the Consumer will be required to confirm with us directly that they provided permission to submit the request.

SECTION 4: Nature of Request

* Please select all desired options:

This request requires filling out Section 5 to specify the method you want to receive the specific pieces of information. Please also complete the declaration in Section 6 to finalize this request.
Please complete the declaration in Section 6 to finalize this request.

SECTION 5: Delivery Options

The e-mail address you provided in Section 1 will be used for correspondence relating to this request. If you made a request to know specific pieces of information you can receive the information electronically or by mail. If you elect to receive the information by mail please provide your mailing address.

SECTION 6: Declaration

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 declaration as required so that we may fulfill your request made pursuant to CCPA.


Declaration in Support of Verified Consumer Request

Click here to download the form. Upload the completed form below or submit it via mail or email


If You choose not to upload this declaration directly You can send it to either:

Mailing Address:
Corporate Center 11335 Northeast 122nd, Kirkland, WA 98034
Email Address:
support.22473.46126a33012ff5f3@helpscout.net Click here for email address
Thank you, your CCPA request has been sent