Data Access Request Form

Submit this Request to Pacific Palms Resort by completing the information below. Please note Pacific Palms Resort must verify your identity before this Request can be processed.
(If you are making this Request on behalf of another person, in Section 1 please provide the requested information pertaining to the person on whose behalf you are making this Request. Then provide documentation of your authority to make this Request, and provide your own information in Section 3.)
Fields indicated with an asterisk (*) or listed as (required) are required elements to complete this form. Your Request will not be processed if you do not complete all required fields.

  • Please indicate who is filling out the form below.
    Select one of the options below.








  • How did Pacific Palms Resort come to possess your personal information? Please check all that apply and provide the additional information required for each selection.*





  • I would like for the company to provide, or complete, the following regarding my personal information:*
    Select one, or more, of the options below.