CCPA Form

Which type of request are you making?
Type of request*
- Access request: I want to know the categories of information that Marchex has about me
- Access request: I want to obtain a copy of specific personal information that Marchex has about me
- Deletion request: I want my personal information removed

Who is submitting this form?
Who is submitting this form*
- I am the consumer
- I am an Authorized Agent acting on behalf of the consumer
Please upload proof of your authorization*
Max. file size: 100 MB.
Authorized Agent Name*
Consumer's Email*

Please confirm the email of the consumer you are acting for so that we can reach out to them to verify their identity.

Provide signature below
By signing below and clicking “Submit” after reviewing your entry, I declare under penalty of perjury that: (1) the information submitted is true and correct; (2) I am a California resident; and (3) I am the consumer who is submitting this information.
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*

Type your name to sign. You will be able to review your information before submitting.

CCPA Request Form for California Residents