California Consumer Privacy Act Request

First Name *

Last Name *

Address *

Email *

Phone Number *

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

Type of Request: *

Know Personal Information Collected or Disclosed
Delete Personal Information

Requestor Type: I am a *

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

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 Phone Number *

Consumer’s Email Address *

Consumer's Street Address *

Consumer's City of Residence *

Consumer's Zip Code *

Loop Loyalty Account Number