California Consumer Privacy Act Request Form

Under the California Consumer Privacy Act ("CCPA"), California residents have the right to know and request access to their personal information collected, used, and disclosed within the past 12 months, and to delete their personal information in accordance with the CCPA. We will not discriminate against you if you choose to exercise any of your privacy rights under the CCPA.

If you are a California resident and you would like to submit a request to know, access, or delete your personal information, please complete and submit the form below. You may also print this form and mail or deliver the completed form to our Los Angeles office at Carlton Fields, 2029 Century Park East, Suite 1200, Los Angeles, California, 90067-2913. You may also email your request to [email protected] or contact us at the following toll-free number: 844.316.3866.

First Name

Last Name

Phone Number

Email Address

Mailing Address

City

State

Zip Code

Preferred Method of Contact

Are You Making This Request on Your Behalf?

Yes No

First Name - Authorized Representative

Last Name - Authorized Representative

Phone Number - Authorized Representative

Email Address - Authorized Representative

Relationship to Consumer

What Are You Requesting?

To know the categories of personal information we have collected, processed and/or shared within the previous 12 months To access the specific pieces of personal information we have collected, processed and/or shared within the previous 12 months To delete my personal information

Relationship to Carlton Fields

Client Former Client Other (please specify)

Other (please specify)

Please provide any additional details regarding this request