Privacy Request Form

This form is for privacy requests concerning individuals who reside in California or Oregon. The person whose personal information or personal data is the subject of this request resides in:

California
Oregon
Neither

This form is currently for privacy requests concerning California and Oregon residents. Please see our Privacy Notice for other available privacy choices or contact privacy@populusfinancial.com.

Who are you submitting this request for?

Myself
Another individual as an authorized agent or legal representative

Note: If you are an authorized agent, please provide your name and contact information and a copy of the consumer's signed permission authorizing you to submit this request. We may ask the consumer to verify their identity directly with us or confirm that they authorized you to act on their behalf. If you are acting under a valid power of attorney, you may provide that documentation instead.

Please provide agent contact information:

Agent or Agency Name

Agent Email

Agent Phone Number

What is the individual's relationship with our company? Select all that apply.

Customer or former customer
Employee, former employee, contractor, temporary worker, or job applicant
Business contact, vendor, landlord, or service provider representative
Other:

Type of Request:

Right to Know Categories of Personal Information We Collect, Use, and Disclose
Right to Know Specific Pieces of Information Collected
Right to Delete Personal Information
Right to Correct Inaccurate Personal Information

To opt out of the sale or sharing of your personal information, including sharing for targeted advertising, select “Manage Preferences” in the cookie banner, turn on “DO NOT SELL OR SHARE MY PERSONAL INFORMATION,” and select “Save.”

Who are you submitting this request for?

Myself
Another individual as an authorized agent or legal representative

Note: We may request documentation reasonably necessary to confirm your authority to act for the Oregon resident.

Please provide agent contact information:

Agent or Agency Name

Agent Email

Agent Phone Number

What is the individual's relationship with our company? Select all that apply.

Customer or former customer
Prospective customer or applicant for a consumer product or service
Other personal or household relationship:

Type of Request:

Access my personal data and obtain information about how it has been used or disclosed
Correct inaccurate personal data
Delete my personal data

Consumer Contact Information

Please provide information you previously used with us so that we can locate your records and process your request. We may contact you if additional information is reasonably necessary to verify your identity or complete your request.

Consumer First Name *

Consumer Last Name *

Address *

City *

State *

Zip Code *

Preferred Contact Method *

I confirm that I would like to submit this request.