California Access/Deletion Web Form

If you are a California resident, the California Consumer Privacy Act (“CCPA”) provides you with certain rights with respect to your data. If you are a California resident, we have created the form below to assist you in submitting these requests. Please see our Privacy Policy for more information about how we collect and use information.

Type of Request:
Provide me information about the categories of personal information you collectProvide me with the specific pieces of personal information you have collected about meDelete the personal information you have collected about me

Provide the below information necessary to process the request:
First Name*:
Last Name*:
Primary Email*:
Email used for Website Email Subscription:
Email used for Willow App Login:
Email used for Website Orders: -or-
WillowPump.com Order #(s)
Serial numbers of your Willow Pumps
(Required if you purchased a Willow Pump Kit)
Address*:
City*:
State*:
Zip*:

I am making the request on behalf of*:
MyselfSomeone Else

If you’re making the request on behalf of someone else, please provide us with the following:†
Your First Name:
Your Last Name:
Your Relationship to the consumer:
(JPG, PNG, PDF up to 10 MB)
† Please upload a power of attorney, or written, signed form allowing you to submit the request on the consumer’s behalf. To complete this request we will also send an email to the consumer at the email provided above so that the consumer can verify their identity.

I certify that I am a California resident and that all information I have submitted is true and accurate.