I am a(n): * Customer Authorized Agent Name * First Name Last Name Email * Name of consumer on whose behalf you are submitting this request (required) First Name Last Name Email address of the consumer on whose behalf you are submitting this request (required) Please upload a copy of written permission, signed by the consumer, demonstrating that you have the authority to make this request. This written permission must include the consumer’s full name, email address, and an authorization for you to act on their behalf. If the consumer has provided you with power of attorney pursuant to California Probate Code sections 4121 to 4131, you may instead upload a copy of the validly executed power of attorney naming you as the consumer’s authorized representative. Upload File UPLOAD (required) 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 informatio If you selected “Request to know about my personal information collection, use, processing, and/or sharing” or “Correct my personal information,” please provide information regarding what information you are requesting, or the corrections that you would like made. Request type(s) (GDPR only): Access Rectify Delete Object to processing Data portability If you selected “Rectify,” please provide information regarding what rectifications you would like made. Country * State * 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 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 Black Tap to complete my request. * I confirm Thank you!
