Verified Consumer Request

Details of Authorized Agent

Nature of Request

Declaration

Please note that any attempt to gain access to personal information through misrepresentation may result in prosecution.

I certify that the information given in this Request to INSP LLC is true and accurate. I understand that INSP LLC is required to verify my / the Consumer’s Identity and I certify that the information given in this request to INSP LLC is true and accurate. I certify under penalty of perjury that I am the consumer whose personal information is the subject of this request.

Please use your finger (if touch enabled), mouse or pen to provide your signature in the box below.

By selecting the E-Signature button, you are signing this Declaration electronically. You agree your electronic signature is the legal equivalent of your manual signature and no other verification is necessary to validate your electronic signature. If you do not consent, check the Manual Signature button below and upload your signed Declaration.