First Name
Last Name
Email
Are you a California resident?
Yes
No
Are you requesting your own information?
Yes
No
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.
Comments
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
. *