Form To Exercise Consumer Rights

I am submitting a request as, or on behalf of: *

California resident
Virginia resident
Resident of another state

NOTE: If you select “Resident of Another State,” the consumer rights are limited to residents of certain states. Because you are not a resident of a state in which those rights are available, we are unable to honor your request at this time. By submitting this form, you acknowledge that your request will result in no action from Affordable Labs.

I am submitting a request on behalf of: *

Myself
Someone else

I, or the individual I am submitting this request on behalf of, am/is a (an): *

Customer of AffordableLabs.org
General consumer

Name *

First

Last

Street Address 1 *

Street Address 2

City *

State *

Zip *

Primary Phone Number *

Email *

Confirm Email

I declare, under penalty of perjury, that I am making this request on my own behalf, or I am authorized to make this request on behalf of the above-named individual, and that all of the foregoing information is true and correct. *

I accept