CCPA Consumer Request Online Form

CALIFORNIA CONSUMER PRIVACY ACT REQUEST

Name:

I am a California resident: Yes No

• NOTE: "Please note you must be a California resident to request information based

on the California Consumer Privacy Act"

Address:

Address 2:

City: State: Zip:

Email:

Phone Number:

Type of Request

Description

Access Request

• Please send me a copy of the information

Cannella Media DTC has collected about me

in the last twelve months.

Request to Know

• Categories of personal information collected

about me in the last twelve months.

• Categories of sources from which the personal

information about me was collected.

• Business purpose for which Cannella Media DTC

uses the personal information collected about me

• Categories of third parties with whom

Cannella Media DTC shares or has shared the

personal information collected about me in the

last twelve months.

Request for Deletion

• Please delete all personal information that

Cannella Media DTC has collected about me.

• Are you sure you want us to permanently

delete all your personal information that

we have collected about you?

Yes No

Request to Opt Out

• Cannella Media DTC does not sell any of the

personal information collected. However, if this

policy changes in the future I request that

Cannella Media DTC refrain from selling my

personal information

Authorized Agent Verification

This request has been submitted through an agent on my behalf: Yes No

Agent's Name:

This agent has been authorized in writing to submit this request on my behalf: Yes No