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First Name

Last Name

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I am requesting this change myself or am legally authorized to act on the person's behalf.

I understand that Canature WaterGroup is required to verify my request and may require me to provide information to enable them to carry out such verification.

I understand that Canature WaterGroup cannot respond to my request or provide me with personal information if they cannot verify my identity or authority to make the request and confirm the personal information relates to me.