CALIFORNIA CONSUMER PRIVACY ACT REQUEST

Name *

First

Last

Address *

Email *

Phone Number *

Requestor Type: I am a *

• Consumer
• Authorized Agent
• Partent/Legal Guardian making a request on behalf of a minor child

Type of Request: *

• Know Personal Information Collected or Disclosed
• Delete Personal INformation

If you are exercising a Right to Know Request, what are you requesting? *

• Categories of Personal Information
• Specific Pieces of Personal Information
• Both Categories and Specific Pieces of Personal Information

Please provide the below information about the consumer who is making the request (or if you are an agent, on behalf of whom you are making this request) so that we may use the information to verify the consumer’s identity. *

First

Last

Consumer's Street Address: *

Consumer's City of Residence: *

Consumer's State of Residence: *

Consumer's Zip Code: *

Consumer's Telephone Number *

Consumer's Email Address *

Loop Loyalty Account Number:

Submit