California Consumer Privacy Act Form

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California Residents Rights:
California Consumer Protection Act of 2018 (“CCPA”) provides California Residents with specific rights regarding Personal Information. In all cases the business is required to verify the resident making the request is the same resident which the business has collected personal information from.

The options below may be selected:
1. Right to access the information. A California resident has the right to request disclosure of the categories and specific pieces of Personal Information the business has collected about the consumer.
2. Right to delete information. A California resident has the right to request the business to delete personal information that the business has collected about the resident.
3. Right to opt-out of the sale of their Personal Information. A consumer has the right to opt-out of their personal information collected being sold by the business.

First Name *

Last Name *

Address *

City *

State *

Zip Code *

Email Address *

Select one or more *

Do not sell my information

Delete my information

I'd like to know what personal information you have on me

I'd like to know what categories of companies you have sold my personal information to

Required

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