Privacy Request Form


  1. Print this form (one form per person).
  2. Indicate your request type.
  3. Indicate your communication preferences.
  4. Provide complete and accurate Contact Information.
  1. Sign and date the form.
  2. Mail to our Privacy Desk at the address below.
  3. Do not send this form by email! Email is not secure.
  4. FMAdata will not send Personal Information by email.

Request Type

Please indicate the type of Privacy Request. Note that some request types require separate verification of your identity.
I would like to opt-out of the sale of my Personal Information.
I request disclosure of the categories, sources, business purpose, categories of third parties, and/or specific pieces of Personal Information held about me (identity verification required).
I request the deletion of my personal information. Please note that removal may not be possible in cases where FMAdata has a legal business purpose to retain Personal Information (identify verification required).

Contact Information

FMAdata generally holds the categories of Contact Information shown below. We require your Contact Information to fulfill your Privacy Request. Please provide complete Contact Information for each item. Be aware that your Privacy Request may be invalid without complete and accurate responses. Respond with "N/A" if a particular item does not apply to you, or if you do not want to opt-out for that item.
(first middle last)
Postal Address:
City, State Zip:

Communication Preferences

I would like to receive communication about my Privacy Request via:
Email at the address above or as indicated to the right:

Postal mail at the address above or as indicated to the right:

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I certify that the information on this Privacy Request Form is accurate and complete as of the date indicated below (Authorized representatives should attach a copy of a signed representation agreement).

Mail To


Privacy Desk
RE: FMAdata
2575 Pearl St, Ste 230
Boulder, CO 80302
  1. FMAdata will respond within 45 days of a verified request.
  2. Contact our Privacy Desk at (888) 598-1101 with questions about this process.
  3. Do not send this form by email! Email is not secure.