REQUEST TO OPT-OUT

DO NOT SELL/SHARE MY PERSONAL INFORMATION - LIMIT USE OF MY SENSITIVE PERSONAL INFORMATION

Some states provide residents (or, in some cases, their authorized agents) with the rights to opt out of “targeted advertising,” “selling,” or “sharing” of personal information and to limit the use of sensitive personal information.

I am: (select one)*

Request Type*

Opt-Out Sale/Sharing of personal information (including for targeted advertising)

By this selection, you are exercising your Do Not Sell and Do Not Share My Personal Information right and your right to opt out of targeted advertising. Please note that your request will apply to future sharing/sale and use of your personal information and will not impact any sharing or use prior to your request.

Limit the use of Sensitive Personal Information (SPI)

Certain types of personal information may be considered SPI under applicable state laws. By this selection, you are exercising your right to limit use and disclosure of your SPI to those uses that are necessary to perform requested services, provide purchased goods, and for other purposes in accordance with applicable law.

Consumer First Name*

Consumer Last Name*

Consumer Email Address*

Residence of Consumer (indicate State)*

Consumer Mailing Address (Line 1)*

Consumer Mailing Address (Line 2)

In the box below, please provide sufficient detail to allow us to properly understand and respond to your request.*

Agent First Name*

Agent Last Name*

Agent Mailing Address (Line 1)*

Agent Mailing Address (Line 2)

Agent Email Address*

An Authorized Agent is required to provide a copy of the consumer's written authorization (for example, a power of attorney) indicating that the consumer has granted the agent the authority to submit a data rights request on behalf of the consumer.

By clicking the “Submit” button, you confirm that the information you have provided is true and accurate. Emson has the right to contact you to verify your identity, the authority of an authorized agent and to process your request.

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