Nature of Request (be specific as possible). Please note how you have interacted with Leviton or its affiliates as a consumer in the past 12 months.

I agree to provide my personal information to Leviton for use in accordance with its Privacy Policy. *

For California residents only. In accordance with the CCPA, I understand that I may be providing the following Categories of Personal Information (as defined in the CCPA) to Leviton by completing this form: Identifiers, Commercial Information, and Internet or other similar network activity, for the purpose of fullfilling my request.

By submitting this form, I certify that the information I have provided is true.

I have read and understand the Warranty Terms and Conditions. *

I have read and understand Leviton's Privacy Policy. *