OxCarCare CCPA Form

First Name

Last Name

Are you a resident of California?

Yes

NOTE: Please note you must be a California resident to request information based on the California Consumer Privacy Act

Address

Address2

City

State

Zip Code

Phone Number

Contract ID (if applicable)

SELECT ALL THAT APPLY:

Request for disclosure (tell me about my data)

Request for access (give me my data)

Request for deletion (delete my data)

Request for correction (correct my inaccurate data)

Requested Through Agent On My Behalf

Yes

Agent First Name

Agent Last Name

CALIFORNIA CONSUMER PRIVACY ACT REQUEST