Data Subject Request Form

Please, enter a valid first name First Name - Required Last Name - Optional Please, enter a valid email Email - Required Please, enter a valid telephone number Telephone Number - Required Please, enter a valid country of residence Country of Residence - Required Please, enter a valid state of residence State of Residence - Required Please, enter a valid select from the following* Select from the following* - Required

Select from the following* I am submitting this request on my own behalf. I am authorized to submit this request on behalf of the individual listed above. Please provide your contact information below.

First Name (applies to the second option of the previous question) - Optional Last Name (applies to the second option of the previous question) - Optional Email Address (applies to the second option of the previous question) - Optional Please leave blank or enter a valid telephone number (applies to the second option of the previous question) Telephone Number (applies to the second option of the previous question) - Optional Please, enter a valid how have you engaged with our company? if submitting a request on behalf of an individual, please identify how that individual has engaged with our company How have you engaged with our company? If submitting a request on behalf of an individual, please identify how that individual has engaged with our company - Required

How have you engaged with our company? If submitting a request on behalf of an individual, please identify how that individual has engaged with our company Current or former employee, job applicant, or contractor Current or former customer in personal capacity Current or former customer on behalf of my employer/business Vendor Other

Please, enter a valid select the type of request that you are submitting as, or on behalf of an individual:* Select the type of request that you are submitting as, or on behalf of an individual:* - Required

Select the type of request that you are submitting as, or on behalf of an individual:* Request to know categories of personal information Request to access specific pieces of personal information Request to correct personal information Request to delete personal information Request to object to processing my personal information Request to restrict processing of my personal information File an appeal