Your Name *

First Name

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The person, or the parent / guardian of the person, whose name appears above.

An agent authorized by the consumer to make this request on their behalf.

I confirm that: (SELECT ALL THREE) *

Under penalty of perjury, I declare all the above information to be true and accurate.

I understand that the deletion or restriction of my personal data is irreversible and may result in the termination of services with PivotPro Partners, LLC

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