Notification of Data Breach

You may provide notice of a data breach to the Arizona Attorney General using this form.

Notifications, information and evidence provided to the Attorney General using this form are confidential pursuant to A.R.S. § 44-1525 and are exempt from disclosure under A.R.S. § 39-101 et seq., but may be used by the Attorney General to investigate the data breach or any related incidents or conduct.

Name of entity/business that experienced a breach

Approximate Date(s) of Breach

Brief description of the alleged breach (including personal information that may have been revealed and how you became aware of the breach)

Additional Information (optional)

Attestation: On behalf of aforementioned person or entity, I attest that the foregoing information is true and accurate to the best of my knowledge.

Name

Phone

Signature

Sign above

Date

If you believe you have been the victim of consumer fraud, you can file a consumer complaint. If you need a complaint form sent to you, you can contact the Attorney General’s Office in Phoenix at (602) 542-5763, in Tucson at (520) 628-6648, or outside the Phoenix and Tucson metro areas at (800) 352‑8431. If you believe that you might be the victim of identity theft, please see additional information. For all other complaints, please visit the “Complaints” section of our website at azag.gov and select the appropriate subject area. Thank you.