CCPA Personal Information Request Form Step 1 of 4 25% Select One:*I am requesting a right under the CCPA for myselfI am requesting a right under the CCPA for someone else Select One:*I am a former customer I am requesting a right for a former customerI am a current customer I am requesting a right for a current customerI am not a customerOther Select As Many As Apply:* I Want to Receive My Personal Information I Want to Delete My Personal Information I Want to Opt-Out of Any Sale of My Personal Information How Shall We Respond To You*E-MailU.S. Postal MailMy informationName* First Name Last Name Phone Number*Email Address* Address* Street Address City State Zip Asserting a Right for (if applicable)Name First Name Last Name Phone NumberEmail Address Address Street Address City State Zip
