Privacy Request Questionnaire

This form is valid only for California residents.
If you live in another state, please make your request via Customer Service (800)-643-1948.

First Name

Last Name

Phone Number

Speedy Rewards # (Optional)

Street Address

Address 2 (Apt., Suite #) (Optional)

City

State

Postal Code

Type of Privacy Request

For identification verification purposes, describe one or more of your last 5 transactions:

Examples of transactions: receipt information such as store number, store address, date, time, purchase information.

Please check all that apply
(at least one must be checked):

You are a Speedy Rewards member.
Your Speedy Rewards card is registered.
You contacted Customer Service for help with your Speedy Rewards account.
You made a purchase through Speedy Rewards Mall.
You made an online purchase through Speedy Café.
You contacted Customer Service to file a customer complaint or compliment.
You contacted Customer Service via Speedway.com or the Speedway Fuel & Speedy Rewards mobile app.
You submitted an accident, injury, incident, or damage claim with Speedway.
You have contacted Speedway for any other reason or provided your personal information to Speedway in any other manner other than to the questions that you were just asked.

Please describe this interaction:

Pursuant to the California Consumer Privacy Act we will respond within 10 days to confirm receipt of your request.

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