CCPA Consumer Rights Request Form

If you are a California resident, you have certain rights under the California Consumer Privacy Act ("CCPA"). Upon submission of a verifiable consumer request, you have the right to request disclosure, correct or delete personal information we have collected from you within the preceding 12 months. For more information regarding the CCPA, please see our Privacy Policy.

Your Contact Info *

If you have a HashMemo account, please enter the same registered email address with the app.

Who is Requesting*

I am the consumer

I am the authorized agent of the consumer

The Authorized Agent Issue

If you are an authorized agent of a California resident and are making this request on his or her behalf, you will be required to provide a copy of the California resident’s written authorization (for example, a power of attorney) showing that you have been granted the authority to submit a consumer rights request on behalf of the California resident.

Attachment (optional)

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Max file size 10MB.

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Select all that apply *

We will respond to the above email address.

Request to Know

Request to Correct

Request to Delete

Please provide details description *

Declaration Statement *

Please confirm that you wish to submit this form:

I swear, under penalty of perjury, that the information in the form is accurate and that I am the California consumer or am authorized to act on behalf of the consumer.

I make this declaration voluntarily and of my own free will. No threats or promises have been made to me to induce me to make this statement.

I understand that I may make a verifiable consumer request twice within a 12 month period.

Your electronic signature should match your full name.

Electronic Signature *

Date of Request*

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