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Consumer Privacy Request Form

Requests must be made by or on behalf of a current resident of California, Colorado, Connecticut, Florida, Montana, Oregon, Texas, Utah, or Virginia. If you would like an authorized agent to make a request on your behalf, please click here to view the “Authorized Agent Request” section below.

I am a *

How we may identify your information:

Please provide the following information so we may identify you, or if you are requesting on behalf of someone else, please provide their information.

Please note that you must provide all of the required information (marked by an asterisk) to enable us to process your request or, for agents, provide documentation demonstrating your authorization to act on an individual’s behalf.

Request Type *

Do not sell or share my personal information

Limit the use of my sensitive personal information (California only)

First Name *

Last Name *

Email associated with your Roundhouse Provisions Account or Purchase *

Certification of Residency or Authorized Agent

By pressing “submit,” I certify that I am a resident of the location above or that I am an authorized agent of a resident of the location above and that all information I have submitted is true and accurate.

I am a

Request Type

Authorized Agent Request

You may designate or authorize a person or an eligible business to act on your behalf as an authorized agent. This authorized agent may make requests on your behalf under the California Consumer Privacy Act (“CCPA”).

To do so, please have your authorized agent send a request to [email protected] with “Authorized Agent Opt-Out Request” in the email subject line, and the following information in the email content:

Your First and Last Name
Your Email Address
The Agent’s First and Last Name
The Agent’s Email Address
The Agent’s Phone Number
A document with your signature indicating that you authorize the agent to make the request on your behalf.
Indicate if the Agent prefers to be contacted via email or phone

We may follow up with you or your authorized agent if we need any additional information prior to processing your request.

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Consumer Privacy Request Form

Authorized Agent Request