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Personal Information Request Form
Full Name
Email
Phone Number
Please enter an IP address, street address, username, or some other identifying trait.
Other identifiers
(Max 256 characters)
Contact information if different from above
Email
Phone Number
Reason for your request
(Max 256 characters)
State of residency
Requestor's relationship with Nextiva
Customer / Former Customer
Other
(Max 256 characters)
Type of request
Right to know (Categories of data)
Right to know (Specific data)
Right to delete
Agent
I am making this request as an Agent of the consumer
No
Yes
Agent name
Agent email
Agent phone numbrer
By submitting information you agree to Nextiva's
Privacy Policies
. Nextiva will use information submitted through this form sole for the purposes of responding to requests about personal information, and will retain this information for at least two years.
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