Welcome to AxQuotes Data Request Form!

If you are a California resident submitting an access or deletion request pursuant to the California Consumer Privacy Act / California Privacy Rights Act (CCPA/CPRA), you may exercise your rights by completing this Data Request Form. Non-California residents do not have such rights under the CCPA/CPRA.

The security of your information is important to AxQuotes. We collect the information below solely to attempt to authenticate your identity and retrieve information for purposes of processing your data request.

Please populate the Form with the information you used during your interaction(s) with AxQuotes. While AxQuotes will do all it can to honor your request, we may not be able to in certain circumstances. For example, if we cannot identify you within our systems, we will not be able to honor your request.

To learn more, please visit our Privacy Center.

"*" indicates required fields

Name*

First Last

What email address do you use to access the website?*

ZipCode*

Select how you have most recently interacted with AxQuotes*

Please select the Line(s) of Insurance related to your interaction(s) with AxQuotes*

Health

Medicare

Life

Auto

Home

Final Expense

Data Request Type*

Access my personal information

Delete my personal information

I am submitting on behalf of the consumer above

Consent*

I do hereby swear, declare, and affirm under penalty of perjury under the laws of the State of California that the information I supplied is true and correct, that I am either (i) the consumer identified in this request, or (ii) authorized to make this request on behalf of the consumer, and (iii) the consumer identified in this request is a resident of the State of California.*

Terms & Conditions
Privacy Center
Do Not Sell nor Share my Personal Information
Contact Us
Communication Opt Out