CCPA Request

All fields with an (*) are mandatory

REQUEST FOR INFORMATION COLLECTED | REQUEST FOR IDENTIFICATION | REQUEST FOR DELETION OF INFORMATION COLLECTED BY RAUSCH STURM (CALIFORNIA RESIDENTS ONLY)

Request

Pursuant to the California Consumer Privacy Act, I hereby declare under penalty of perjury that the information provided above is true and correct and that I (the individual described above) am the individual that is providing the information above.

By submitting this form I am authorizing Rausch, Sturm, Israel, Enerson & Hornik LLP to contact me using the phone numbers or email address supplied.