California Consumer Privacy Act Verified Information Request
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First Name
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Last Name
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E-Mail Address
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Gender
Choose
Female
Male
I prefer not to specify
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Address (Apt#)
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City
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State
KY
AB
AK
AL
AR
AZ
BC
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MI
MN
MO
MS
MT
NB
NC
ND
NE
NF
NH
NJ
NM
NS
NT
NT
NV
NY
OH
OK
ON
OR
PA
PE
QC
RI
SC
SD
SK
TN
TX
UT
VA
VT
WA
WI
WV
WY
YT
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Zip Code
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Phone
Home
Mobile
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Birth Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
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Birth Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
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Birth Year
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What radio station is this request in reference to?
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Item(s) requested:
Personal Data Request
Request for My Data Not to Be Sold
Request to Be Forgotten
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In order for this request to be processed in full compliance with the California Consumer Privacy Act, under penalty of the law, I represent that I am a citizen of the state of California and the person indicated in this Verified Information Request. Information will not be released to an Unverified Individual. As a result, my responses to any such verification requests will be completed in a timely manner or risk delaying the completion of this request.
If you are having trouble submitting your request, please
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.