1stMILE California Consumer Request Form

Requestor First Name

Requestor Last Name

Requestor Email

Requestor Address

Requestor City

Requestor US State Requestor US StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingWashington DCARMED FORCES AFRICA \ CANADA \ EUROPE \ MIDDLE EASTARMED FORCES AMERICA (EXCEPT CANADA)ARMED FORCES PACIFIC

Requestor Phone

Requestor Zip

Are you the consumer? Are you the consumer? Yes, I am making a request related to personal information about me. No, I am acting as an authorized agent for the consumer. I understand that the request cannot be processed without a California Authorized Agent Designation form 1stMILE CCPA Authorized Agent Designation Form completed and signed by the consumer. Download the 1stMILE CCPA Authorized Agent Designation Form

Consumer First Name

Consumer Last Name

Consumer Email

Consumer State of Residence Consumer State of ResidenceAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingWashington DCARMED FORCES AFRICA \ CANADA \ EUROPE \ MIDDLE EASTARMED FORCES AMERICA (EXCEPT CANADA)ARMED FORCES PACIFIC

Specify the request(s) - check all that apply Specify the request(s) - check all that apply Request to delete personal information 1stMILE has collected from the consumer Request to know categories of personal information 1stMILE has collected, used, and disclosed about the consumer Request to obtain specific pieces of personal information 1stMILE has collected about the consumer Declaration

Declaration Declaration BY CLICKING “SUBMIT,” I HEREBY CERTIFY THAT THE INFORMATION ENTERED INTO THIS FORM IS COMPLETE, ACCURATE, AND UP-TO-DATE, AND THAT I AM THE CONSUMER WHO IS THE SUBJECT OF THE REQUEST OR HAVE BEEN LEGALLY AUTHORIZED BY THAT CONSUMER TO ACT ON HIS/HER BEHALF, AS INDICATED ABOVE. I UNDERSTAND THAT IT MAY BE NECESSARY FOR 1STMILE TO VERIFY THE IDENTITY OF THE CONSUMER AND/OR AUTHORIZED AGENT FOR THIS REQUEST, AND ADDITIONAL INFORMATION MAY BE REQUESTED FOR THIS PURPOSE.