Hospital Beds, Support Surfaces, and Mobility Equipment

The categories of personal information the business collected about the consumer
The categories of sources from which personal information is collected
The business or commercial purpose for collecting or selling personal information
The categories of third parties with whom the business shares personal information
The specific pieces of personal information the business has collected about the consumer (may require additional verification)
The categories of the consumer’s personal information that were sold or disclosed for business purposes in the 12 months preceding the consumer’s verifiable request

First Name including all variations (i,e, Bill, Billy, William, etc.):
Last Name:
Date of birth:
Phone Number:
Email:
Address:
Employee number/Agent Reference (if applicable):
Description of your last two transactions with Sizewise Rentals, L.L.C.:	(required if making a request for specific information or to delete your personal information)
Required information (check all that apply):	The categories of personal information the business collected about the consumer The categories of sources from which personal information is collected The business or commercial purpose for collecting or selling personal information The categories of third parties with whom the business shares personal information The specific pieces of personal information the business has collected about the consumer (may require additional verification) The categories of the consumer’s personal information that were sold or disclosed for business purposes in the 12 months preceding the consumer’s verifiable request
Request to delete personal information:	All personal information Specific personal information
Request to opt-out of personal information sales:	All personal information sales Specific personal information sales
Request to opt-in to personal information sales:	All personal information sales
Signature and Date:	By signing below, you indicate that you are the individual named above. If you are making a request to know specific pieces or information or have your personal information deleted, you declare under penalty of perjury that you are the consumer whose personal information is the subject of the request. Sizewise Rentals, L.L.C. cannot accept requests regarding your personal data from anyone else, including family members, unless evidence is provided of authority to act on your behalf. We may need to contact you for further identifying information before responding to your request. You warrant that you are the individual named and will fully indemnify us for all losses, cost and expenses if you are not. You understand that for your safety and to comply with CCPA, Sizewise Rentals, L.L.C. can only provide you with your information in an encrypted format. By providing your mobile number, you authorize Sizewise Rentals, L.L.C. to text message you on your mobile device with the password. Please allow up to 45 days for a response.

Sizewise Rentals, L.L.C.

CCPA Consumer Request Form