Consumer Request FormLisa Winger2020-01-13T14:38:12+00:00 Consumer Request Web Form If you are a California resident and would like to submit a Consumer Request under the California Consumer Privacy Act (CCPA), please fill out and submit the below web form. Are you a California resident? By clicking yes below, you certify and declare under the penalty of perjury that you are a resident of California:1. California Residency *Yes2. Relationship to Consumer *Self Parent/Guardian Authorized AgentIf you are a parent/guardian submitting a request related to your minor children, please see sections 15-16 for additional information you must provide.If you are an authorized agent, please see sections 15-16 for additional information you must provide.3. Request Type *Request to Know Specific Pieces of Personal InformationRequest to Know Categories of Personal InformationDo Not Sell My Personal InformationRequest to Delete My Personal InformationIf you have multiple requests, please submit a separate form for each request.4. Consumer's First Name *5. Consumer's Middle Initial6. Consumer's Last Name *7. Consumer's Email Address *8. Consumer's Phone Number *9. Consumer's Country *AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d’IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor-Leste)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFijiFinlandFranceGabonThe GambiaGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesia, Federated States ofMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmar (Burma)NamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorth MacedoniaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamYemenZambiaZimbabwe10. Consumer's State *11. Consumer's Postal Address *12. Consumer's City *13. Consumer's Zip code *14. Preferred Method of Response Delivery *Secure Electronic DeliveryPhysical Mail 15. Parents/Guardians If you are a parent/guardian submitting a CCPA rights request related to your minor child, please email a written notarized statement under penalty of perjury (and fraud) that you are the guardian of the minor whose CCPA rights you are seeking to exercise. If you do NOT provide the signed notarized statement, we cannot honor any request you submit on behalf of a minor child. After submitting your request through the webform, please email your notarized statement as an attached PDF to ccpa@goldco. The subject line of the email should read as "Parent/Guardian - Notarized Statement - [Request ID]". The Request ID must be included and will be displayed after this web form is submitted. 16. Authorized Agents If you are serving as an authorized agent for a California consumer, please email a written notarized authorization form from the consumer that you represent, or a Power of Attorney document, authorizing you to serve as the consumer's agent for the purposes of exercising the consumer's rights under the CCPA. If you do NOT provide the signed authorization, we cannot honor any requests you submit on behalf of a consumer. After submitting your request through the webform, please email your notarized statement attached as a PDF to ccpa@goldco. The subject line of the email should read as "Authorized Agent - Notarized Authorization - [Request ID]". The Request ID must be included and will be displayed after this web form is submitted.Let us know you are human. Please answer the question below. *What is the fourth letter in the alphabet?CommentSubmit