DATA REQUEST

I am a(n) *

Customer

Authorized agent

If you are an authorized agent, please complete the following:

First Name

Last Name

Request type(s) (certain US states only) *

Request to know about my personal information collection, use, processing, and/or sharing

Request a copy of my personal information

Correct my personal information

Delete my personal information

Request type(s) (GDPR only):

Access

Rectify

Delete

Object to processing

Data portability

Mailing Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

I understand that I may be required to validate my request and/or my identity and that I may be contacted in order to for Octillion to complete my request. *

I confirm

Under penalty of perjury, the information I have provided above is true and correct, and I am the person, or the authorized agent of the person, whose name appears above. *

I confirm