California Consumer Privacy Act (CCPA)

California Consumer Privacy Act (CCPA) Request Form

If you wish to submit (1) a request to know categories of information collected, (2) a request to know specific pieces of information collected, (3) a request to correct inaccurate personal information or (4) a request for deletion of personal information, please complete the form below. Please note that you must submit a separate request for each type of request that you wish to make.

Upon receiving your request, we will confirm receipt within 10 business days and provide information about how we will process the request. Typically, we will respond to your request within 45 calendar days from the day we receive your request. In certain circumstances, we may need additional time to respond to your request. If we do, we will notify you of the need for an extension before the end of the initial 45 days, but in any event, you will receive a response to your request no later than 90 calendar days from the day we receive your request.

If we require additional information in order to verify your identity, respond to your request, or if your request is deficient in any respect, we may contact you requesting additional information or explaining how to remedy any deficiency in your request, if applicable.

I affirm that I am a California resident or an authorized representative of a California resident as defined by Section 17014 of Title 18 of the California Code of Regulations.

I am.
I am not.

These rights are for California residents only.

Individual Making the Request:

I am the consumer about whom the request pertains.
I am an agent of the consumer about whom the request pertains.

Note, if you are an agent of the consumer about whom the request pertains, in addition to the information requested about the consumer on the next page, please email us at caprivacy@populusfinancial.com and provide the following information:

1. To verify your authorization to request on behalf of a California resident, please attach a copy of one or more of the following to your email:

- California Secretary of State authorization,
- written permission from the California resident, or
- power of attorney.

2. To verify your identity, please attach copies of the following to your email:

- valid Government Issued ID (not expired), AND
- a Utility Bill, Bank Statement, or similar documentation to verify your name and address.

3. Please provide agent contact information:

Agent or Agency Name

Agent Email

Agent Phone Number
I am a business contact whose personal information may have been collected through my business interactions with your company.

Type of Request:

Request to Know Categories of Information Collected
Request to Know Specific Pieces of Information Collected
Request for Deletion of Personal Information
Request to Correct Inaccurate Personal Information

Consumer Contact Information

First Name

Last Name

Address

City

State

Zip Code

Phone Number

Email Address

Business Contact Information

Business Name

Business Phone Number

Consumer's Contact Person at PFG, if known

By submitting this request, I declare under penalty of perjury under the laws of the State of California that I am, or am the proper agent of, the person about whom this request pertains.

I confirm that I would like to submit this request