By submitting this Request Form to you, I certify that I am a resident of either California, Colorado, Connecticut, Montana, Oregon, Texas, Utah or Virginia, who wishes to exercise my rights to make a request under my state’s Consumer Privacy Act. I understand that you may be required to keep a record of my request for at least 24 months, including any reference number assigned to my request, the request date and nature of the request, the manner in which the request was made, the date and nature of your response, and the basis for the denial of the request if the request is denied in whole or in part.