Data Request Form

To submit a data-request, please print out this page, and send it by postal mail to:

Lakehome Games, LLC

3509 Federal Drive

Ste 111

Eagan, MN 55122

Our privacy policy is available online at www.myubicoin.com/privacy

Data Request Form

First Name: _________________________________________________________________________

Last Name: _________________________________________________________________________

Email Address: _________________________________________________________________________

Purpose of Request:

How will the data be used? Who is the intended audience?

_________________________________________________________________________

Data Request Description:

Please be as concise and as detailed as possible in your request. The more detailed you are, the better able we are to fulfill your request.

_________________________________________________________________________

When would you like to have the data:

We will make every effort to meet your desired date. More complex requests may take longer to process. The standard time frame for processing data requests is 5-10 business days from date of approval.

Date: _________________________________________________________________________

All requests for data are subject to approval and compliance with all Federal, State, and local laws as well as Lakehome Games, LLC policies.

Once you have submitted your request, you will receive a computer-generated email acknowledgement within 1 - 2 business days. You will also receive a direct communication from the Lakehome Games, LLC Data Protection Officer within 5 business days.