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By submitting this Request Form to you, StreetTrend, I certify that I am a California resident who wishes to exercise my rights to make a request under the California Consumer Privacy Act (CCPA). I understand that you are required to keep a record of my request for at least 24 months, including any reference number assigned to my request, the request date and nature of the request, the manner in which the request was made, the date and nature of your response, and the basis for the denial of the request if the request is denied in whole or in part.
I understand that your response(s) to my request will be in writing and I authorize you to provide your response(s), send verification of receipt of my request, or contact me in connection with my request, using the following contact information and method(s) of delivery:
My Full Name*
My Mailing Address*
My Email Address*
I understand that you need to be reasonably sure that I am making this request regarding my own information, or that I am authorized to make a request about someone else’s information. Therefore, I am providing the information below, which is accurate to the best of my knowledge, for purposes of allowing you to attempt to verify my request. I understand that you will use the verification data provided to cross-check information available in your existing records to the extent possible, and that you may contact me to request additional information and/or deny my request if the information provided is insufficient for purposes of verification. (Check appropriate box and provide associated verification information as applicable):
Here is my information for verification purposes):
My Full Name
My Shipping address
My Primary Telephone Number
My Most Recent Item(s) Purchased
Full Name of Minor
Address of Minor
Minor’s Date of Birth
My Relationship to Minor (Parent or Legal Guardian)
For verification purposes, please be prepared to send proof of parentage or guardianship. Acceptable forms of proof include a birth certificate or relevant court document establishing status with respect to a minor child.
Full Name of Person Whose Information is at Issue
Address of Person Whose Information is at Issue
Email Address of Person Whose Information is at Issue
For verification purposes, please be prepared to send a Signed Power of Attorney or proof of registration with the California Secretary of State as a Designated, Authorized Representative of the California consumer whose information is at issue.
Optional Restriction: I would only like to receive copies of the following Personal Information/Categories of Personal Information from your records:
Please be prepared to provide a Declaration Under Penalty of Perjury Confirming you are the California consumer whose personal information is at issue.
Optional Restriction: I would only like you to delete the following Personal Information/Categories of Personal Information from your records:
Please understand that we are required to re-confirm with you prior to doing so that you really want this information deleted.
If you have any questions about this request form or your CCPA rights, you may contact us at email@example.com or 1-855-956-5135.