Consumer Rights Request Form

{"formName" : "consumerRightsRequest", "emailSubject": "Consumer Rights Request", "missedRequesterTypeErrorMsg": "You have to choose the requester type", "fields":[ { "name":"firstName", "type":"text", "label":"First Name", "required":true }, { "name":"lastName", "type":"text", "label":"Last Name", "required":true }, { "name":"emailAddress", "type":"email", "label":"Email Address", "required":true }, { "name":"phoneNumber", "type":"text", "label":"Phone Number"}, { "name":"placeOfResidence", "type":"text", "label":"Place Of Residence(State, Country)", "required":true }, { "name":"orderNumber", "type":"text", "label":"[Order confirmation number]" }, { "name":"accessToYourPersonalInformation", "type":"checkbox", "label":"Request access to your personal information" }, { "name":"correctInaccuratePersonalInformation", "type":"checkbox", "label":"Request to correct inaccurate personal information about you" }, { "name":"deletePersonalInformation", "type":"checkbox", "label":"Request to delete your personal information" }, { "name":"optOutOfTheSaleOrSharingOfYourPersonalInformation", "type":"checkbox", "label":"Opt out of the sale or sharing of your personal information" }, { "name":"individualRequester", "type":"checkbox", "label":"The individual who is the subject of this request." }, { "name":"thirdPartyRequester", "type":"checkbox", "label":"A third party acting on behalf of the person who is the subject of this request (“authorized agent”)." }, { "name":"thirdPartyFirstName", "type":"text", "label":" ThirdParty First Name" }, { "name":"thirdPartyLastName", "type":"text", "label":"ThirdParty Last Name" }, { "name":"thirdPartyEmailAddress", "type":"email", "label":"ThirdParty Email Address " } ] }

First Name

Last Name

Email Address

Phone Number

Place Of Residence (State, Country)

Order Confirmation Number

Type of Request(s) (Check all that apply):

Request access to your personal information

Request to correct inaccurate personal information about you

Request to delete your personal information

Type Of Requester:

I hereby certify that I am (check one):

The individual who is the subject of this request.

A third party acting on behalf of the person who is the subject of this request (“authorized agent”).

If you are not making this request on your own behalf, please provide the following additional details:

First Name

Last Name

Email Address

Additional Requirements for Authorized Agents

If you are submitting this request as an authorized agent, you are required to submit proof of your authorization to make this request, such as a valid power of attorney or proof that you have signed permission from the individual who is the subject of the request. Please email us this proof of authorization to [email protected]. Please do not provide any sensitive personal information in connection with this request, such as a driver's license or other government-issued ID. In some cases, we may be required to contact the individual who is the subject of the request to verify his or her own identity or confirm you have permission to submit this request. Where required by law, we may ask you to provide additional information to confirm your identity. Please monitor your inbox for a follow-up email from [email protected]. Requests may be denied if they cannot be verified or confirmed.

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Consumer Rights Request Form

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Type of Request(s) (Check all that apply):

Type Of Requester:

Additional Requirements for Authorized Agents