Data Access Request Form

NOTE: If you are attempting to submit this form as an authorized agent on behalf of a California resident, please contact us at prior to completing and submitting the form.

Your rights with regards to your data will vary depending on where you live. For more information on specific rights for the jurisdictions that we target, please refer to our Privacy Policy. This form can be used by individuals to request:

  • information about the personal information that we collect about you,
  • your right to access the personal information that we collect about you,
  • your to access the personal information that we collect about you in manner that is easy for you to understand (data portability),
  • deletion of your personal information held by PGM, and
  • your right to withdraw your consent for the processing of your personal information.

The information provided in this form is only for informational purposes. PGM will use this information to evaluate and verify your request. Because certain rights are only available to individuals residing in certain jurisdictions, submitting this form does not guarantee PGM will be able to fulfill your request. After receiving and processing your request, a PGM representative will contact you regarding your submission. We may require additional information to confirm your identity or to identify your records in our system.

If you have questions, you may contact or call our Toll Free Number at 844-271-9198.

Describe your request (check all that apply): *

The following boxes indicate your understanding and acknowledgement of the following conditions and must be checked for PGM to process your request(s).

Acknowledgments: *
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