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CCPA Third Party Request Form

If you are a California resident and want to authorize someone else to submit a request for information and/or a request to delete on your behalf pursuant to the California Consumer Privacy Act of 2018 (CCPA), please complete this form and provide it to the person you are authorizing to submit a request on your behalf. They will be asked to provide the form when they submit your request. AMI COLÉ will use the information in this request form and respond to a request made on your behalf in accordance with the CCPA. AMI COLÉ will maintain a record of your request pursuant to Civil Code section 1798.105(d).

First name*

Last name*

Street Address*

Apartment, Suite, Floor, etc*

City*

Zip code*

Phone number*

Email address*

I am a California resident

I hereby authorize a request for my personal information and/or a request to delete my personal information pursuant to the CCPA.

I hereby request the following from AMI COLÉ (check all that apply)

Inform me about what categories of personal information AMI COLÉ has collected about me

A copy of my personal information

Deletion of my personal information

By submitting this form I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

Name*

Address*

Phone number*

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