1. Consumer Information
2. Type of Request
3. Who is submitting this form?
4. Confirmation and Signature
First Name*
Last Name*
Email Address*
Phone Number*
Alternate Phone Number
Zip Code where you reside*
Reason you think Archenia may have your Personal Information:*
Next
Access request: I want to know the categories of information that Archenia has about meAccess request: I want to obtain a copy of specific personal information that Archenia has about meDeletion request: I want my personal information removed
Previous
I am the consumerI am an Authorized Agent acting on behalf of the consumer
Please upload proof of your authorization*
Authorized Agent Name*
Consumer's Email*
By signing below and clicking “Submit” after reviewing your entry, I declare under penalty of perjury that: (1) I am duly authorized by the California resident on behalf of whom this request is being submitted; and (2) the information submitted is true and correct.
E-Signature*
