FOR CALIFORNIA RESIDENTS ONLY.

Residents of other states are not entitled to use the following form.

Verifiable Consumer Request: In order to process your request for Data Deletion, Portability, and/or Information Disclosure, please complete this form with your current and accurate information to make a verifiable consumer request. This information must match what we have in our system in order to be validated for your protection, with the validity determined by us in our reasonable, good faith discretion. All requests must first be authenticated before proceeding. Information submitted through this form will be used only to process your request, but must be complete and valid.

By submitting an Information Disclose Request through this form electronically, you will receive only the categories of data we have for you. In order to receive the specific data we have for you, you must print, sign, scan, and email this form to [email protected] At least three data points must match the data we have on file to receive this specific information.

*denotes required fields

*First Name

*Last Name

*Email

*Phone

*Street Address

*City

*State

*Zip Code

Please select one: *
Data Deletion RequestData Portability Request (the specific information that we have collected about you)Information Disclosure Request (where we collected your information from, to which parties we shared it with, the associated business purposes for each and additional required disclosures)

• Users with disabilities (and any other users) who wish to make a data deletion request, data portability request and/or information disclosure request can also contact us by emailing us at: [email protected]; calling us at: (877) 255-2761; or sending us U.S. mail to: 4491 Cheshire Station Plaza Unit #2000 Dale City, VA 22193.

• Where you make a data deletion request, data portability request and/or information disclosure request through an authorized agent, we will require that you or the authorized agent provide us with a valid written authorization executed by both parties, with the validity of such document determined by us in our reasonable, good faith discretion. Please submit such documentation to us at: [email protected], or 4491 Cheshire Station Plaza Unit #2000 Dale City, VA 22193.

• We will only use personal information in a verifiable consumer request to verify the requestor's identity or authority to make the request.

• You may only make a verifiable consumer request for access or data portability twice within a twelve (12)-month period.

For additional discussion of your privacy rights, please visit our Privacy Policy by Clicking Here.