In certain states (such as California, Colorado, Connecticut and Virginia), you may submit this form to make certain requests
applicable to your request. In certain circumstances, we may require additional information if we are unable to verify your request based
on the information you provided. The information submitted on this form will be used for the purpose of processing your request.
Residents of California, Colorado, and Connecticut may designate an authorized agent to submit a request on your behalf to access or delete your Personal Information. To do so, you must: (1) provide that authorized agent written and signed permission to submit such request; and (2) verify your own identity directly with us. Please note, we may deny a request from an authorized agent that does not submit proof that they have been authorized by you to act on your behalf.