CCPA Request

    By submitting this Request Form to you, VeriFacts, 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 ticket 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.

    REQUESTOR'S CONTACT INFORMATION

    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:

    VERIFICATION INFORMATION

    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):

    By Checking this Box, I confirm that I am authorized to provide, and do hereby provide, consent for you to take action regarding and/or release to me information regarding the minor child.

    NATURE OF REQUEST

    The nature of my request is as follows, and I understand that I am only permitted to make a verifiable consumer Request to Know or Request to Access regarding my data under the CCPA twice in any 12-month period. (Check appropriate box and provide associated information as applicable).

    I would like to know for the past 12 months:

    • The categories of Personal Information you have collected about me;
    • The categories of sources from which that Personal Information has been collected;
    • The categories of Personal Information collected about me that have been sold or disclosed to others for a business purpose; and
    • The categories of Third Parties to whom the Personal Information collected about me has been sold or disclosed for a business purpose.

    I would like to receive a copy of the Personal Information collected about me for the past 12 months. Unless otherwise noted here, I would like to receive copies of all such information. I am aware that certain information will not be disclosed to me, even if my CCPA request is verified, such as my social security number. I am also aware that you are not required to disclose specific pieces of personal information to me, as opposed to categories, unless I provide to you a written declaration under penalty of perjury stating that I am the consumer whose personal information is the subject of this request.

    If you have any questions about this form or your CCPA rights, you may contact us at ccparequests@verifactsinc.com or 1-844-797-8656.

    Our Privacy Policy is also available online, at https://verifactsinc.com/privacy.