Company (Billing Location)
Date
Your Leviton Account Number
Person Authorizing Change
Phone Number
Extension
Is your company interested in receiving Leviton's ASN's via e-mail?
Yes
No
Email
Comments
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
. *