Privacy Rights Request Form

Privacy Rights Request Form – FlowWells
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Your Privacy Matters

Privacy Rights Request Form

Exercise your personal data rights under US state privacy laws. We process all requests within the legally required timeframe.

1
Your Info
2
Request Type
3
State Rights
4
Verification
5
Submit

Request Submitted Successfully

Thank you. We have received your privacy rights request and will respond to your email address within the timeframe required by applicable law. Please keep your reference number for your records.

Section 1

Your Personal Information

Please provide accurate information so we can verify your identity and locate your data in our systems. All fields marked with * are required.

First name is required.
Last name is required.
We'll send all correspondence about your request to this address. A valid email address is required.
Optional, for identity verification only.
Please select your state.
Providing an order number helps us locate your data more quickly.
Section 2

Type of Privacy Request

Select all that apply. You may submit multiple request types at once.

Section 3

State-Specific Privacy Rights

Depending on your state, you may have additional rights under specific state privacy laws. Please indicate any additional rights you wish to exercise.

Note: We honor privacy rights for all US residents to the extent required by applicable law. The rights available to you depend on your state of residence (selected above) and may vary.
Section 4

Authorized Agent

If someone else is submitting this request on your behalf (such as a legal representative or family member), please complete this section.

Important: As an authorized agent, you must provide proof of authorization. We may contact the data subject directly to verify the request before processing.
Section 5

Identity Verification

We are required to verify your identity before processing your request to protect your personal data from unauthorized disclosure or deletion. Please select a verification method.

This information is used for identity verification only and will not be stored beyond the verification process.
Section 6

Declaration & Consent

Please review the following declaration before submitting your request.

By submitting this Privacy Rights Request Form, I declare under penalty of perjury that:

1. The information I have provided is accurate and complete to the best of my knowledge.

2. I am the individual whose personal information is the subject of this request, or I am an authorized agent with legal authority to submit this request on behalf of that individual.

3. I understand that FlowWells may need to verify my identity before processing this request and may contact me for additional information.

4. I understand that FlowWells will respond to this request within the timeframe required by applicable law (45 days for most US state laws, with a possible 45-day extension with notice, or 90 days for California CCPA requests).

5. I understand that certain exemptions may apply, and some or all of my request may be declined if exemptions are applicable, with an explanation provided.

6. I understand that exercising my privacy rights will not result in discrimination against me for goods, services, pricing, or quality of service, as prohibited by applicable law.

Your submission is protected. We process personal data for this request under our Privacy Policy.