U.S. Privacy Rights Request Form

Depending on your state of residence and subject to certain legal limitations and exceptions, you may be able to exercise certain rights regarding your personal data. Please complete this form to submit a request to exercise one or more of the rights identified below and further described in the Your Privacy Choices section of the Additional U.S. State Privacy Disclosures of our Privacy Notice. We use the data you submit to process your request, prevent fraud and comply with legal obligations. We maintain a record of your request for no less than 24 months.

YOUR PRIVACY CHOICES

Right to Know

Right to confirm whether we are processing personal data about you and, under California and Oregon law only, to obtain certain personalized details about the personal data we have collected about you.

Right to Access / Portability

Right to obtain access to the personal data we have collected about you and, where required by law, the right to obtain a copy of the personal data in a portable and, to the extent technically feasible, readily usable format.

Right to Correction

Right to correct inaccuracies in your personal data, taking into account the nature of the personal data and the purposes of the processing.

Right to Control Over Sensitive Information

Right to exercise control over our collection and processing of certain sensitive information.

Right to Deletion

Right to have us delete the personal data we maintain about you.

Right to Appeal

Right to appeal a decision made in connection with your privacy request.

NOTE: Fields marked with an asterisk (*) must be completed in order to submit this form. Complete the fields below using the appropriate information.

*Identify your relationship with us:

*Select the consumer right(s) you would like to exercise:

Please choose...

Right to Know

Right to Access / Portability

Right to Correction

Right to Control Over Sensitive Information

Right to Deletion

Right to Appeal

*First Name:

*Last Name:

*Email:

*State of Residence:

*Member Number:

Product or Service Name:

Authorized Agent Name: (if applicable)

Authorized Agent Email: (if applicable)

Additional Comments:

Authorized Agents only:

If you are an Authorized Agent submitting a request on behalf of another person, you must attach in the attachment section below either (i) a valid power of attorney or (ii) a signed letter containing your name and contact information, the name and contact information of that person, and a statement of authorization for the request.

Upload Attachments:

Files may not be larger than 3MB.

By submitting this request, I hereby certify under penalty of perjury that (i) I am submitting this request on my own behalf or on behalf of a person for whom I am authorized to act and (ii) the information I have provided is true and accurate.