CCPA Information Request

Requestor Information

In order for us to process your request please complete this form and follow all instructions.
A separate form is required for each user.


Does your request relate to personal data about yourself? (required)
I am the consumerI am submitting request for the consumer

Declaration

By completing this form I declare that the details on this application are to the best of my knowledge correct. I understand that it may be a criminal offense to obtain (or to attempt to obtain) disclosure of personal data unlawfully.
YesNo

Follow-up

After you submit this report you will be issued a "Request Key". Using this request key you will be able to access the Follow-Up functionality of this report.

Follow-Up will allow you to:

  • Upload/Attach documents to this report
  • Respond to follow-up questions/comments
  • Provide additional information

Contact Information

4877 Galaxy Parkway
Suite I
Cleveland, OH 44128

Toll Free: (888) 901-4647
Local: (216) 514-7480
Fax: (888) 901-4648

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