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
that we provide disclosures about or access to, in a portable and (if technically feasible) readily
usable form: the specific pieces and categories of personal information that we have collected
about you in the past twelve (12) months (from the date of our receipt of the request); the
categories of sources from which your personal information was collected; the categories of
personal information we sold or shared about you and the categories of third parties to which
each category of personal information was sold or shared; the categories of personal information
we disclosed about you for a business purpose and the categories of persons to which the
personal information was disclosed; and the business or commercial purposes for collecting,
selling, or sharing your personal information. California residents also have the right to submit a
request for deletion of their personal information under certain circumstances; and the right to
correct inaccurate personal information.
California residents also have the right to opt out of the sale or sharing of their personal
information via cookies and tracking technologies on our websites. To opt out of the sale or
sharing of your personal information, click the “Do Not Sell or Share My Personal Information”
button in the footer of our websites.
* indicates a required field
FIRST NAME * ______________________________________________
MIDDLE NAME (OPTIONAL) ______________________________________________
LAST NAME * ______________________________________________

? Request for disclosure (tell me about my data)  
? Request for access (give me my data)  
? Request for deletion (delete my data)  
? Request for correction (correct my inaccurate data)

Additional information needed to verify your identity for request processing
* indicates a required field
TODAY'S DATE ______________________________________________
ADDRESS 1 ______________________________________________
ADDRESS 2 ______________________________________________
CITY ______________________________________________
STATE ______________________________________________
POSTAL CODE ______________________________________________
ORDER NUMBER (IF KNOWN) __________________________________________

DATE OF RECENT PURCHASE (IF KNOWN) _____________________________________
CONTACT PHONE * ______________________________________________
CONTACT EMAIL * ______________________________________________
Please indicate how you would like to receive the information requested above by checking one
of the following boxes.
   ? By Mail (at Address above)  
   ? By Email (at Email above)

Prior Information (optional)
You may also submit prior information.


? I understand that I may make a verifiable consumer request twice within a
twelve (12) month period. If I have submitted a request for deletion, I understand
that, while I have the right to request deletion of my personal information, KMC
or its affiliate may be able to retain some or all of the personal information for a
variety of ?reasons, such as to comply with a legal obligation.? I further understand
that KMC or its affiliate will respond to my request as necessary using the
information I provided above.

For more information on your rights under the CCPA, please see our privacy policy.