LEADERONE CONSUMER REQUEST FORM

Please note that all of this information is requested in order for us to confirm your identity and process your request. We may also need to request additional information from you to verify your identity and determine the propriety of your request, before we provide a substantive response.

Your First Name: *

Your Last Name: *

Your Email: *

Address: *

City: *

State:

Postal Code: *

I am a (check the box(es) as applicable):

Prospective Customer

Current Customer

Former Customer

Former Employee

Current Employee

Vendor / Contractor

Other:

Please identify your request(s) (check the box(es) as applicable):

Disclosure of personal information collected / disclosed.

Opt-out of selling personal information

We will ask for some additional verification to comply with this request in order to protect your privacy. We may also need to request additional information from you to verify your identity and determine the propriety of your request, before we provide a substantive response. We cannot respond to your request or provide you with personal information if we cannot verify your identity or authority to make the request and confirm the personal information relates to you.

We endeavor to respond to a verifiable consumer request for access or deletion within forty-five (45) days of its receipt. If we require more time (up to 90 days), we will inform you of the reason and extension period in writing. The response we provide will also explain the reasons we cannot comply with a request, if applicable. We will respond to an appropriate request to opt-out within fifteen (15) days of receipt.

Any disclosures we provide will only cover the 12-month period preceding LeaderOne’s receipt of this request. For data portability requests, we will select a format to provide your personal information that is readily useable and should allow you to transmit the information from one entity to another entity without hindrance.

You may only make a verifiable consumer request for access or data portability twice within a 12-month period. These requests are free, though we reserve the right to implement a reasonable fee for excessive or complex requests you may submit.

Making a verifiable consumer request does not require you to create an account with us. We will only use personal information provided in this request form to verify your identity or authority to make the request