CA Privacy Request Form – Smile Brands Inc

CCPA Privacy Request Form

Your privacy requests processed as part of the California Consumer Privacy Act.

All Fields Required.

Name*
First Last
Email*
Phone*
Address*
Street Address Address Line 2 City State ZIP Code
I am a (an):*
Birthday*
Date Format: MM slash DD slash YYYY
BNDI #*
Privacy Request – I would like to request the following:*
Please share any specific questions or concerns related to your personal information:
Phone
This field is for validation purposes and should be left unchanged.