CCPA Consumer Request Form for California Residents

This form is for California residents only. If you are not a resident of California, please review our Privacy Policy for more information about your choices regarding the personal information we collect about you and how to contact us.

If you are a California resident and would like to submit a consumer request under the California Consumer Privacy Act (CCPA), please complete and submit the below web form. We will send a confirmation email to the email address below, if you successfully submit this form; in order to complete your request, you must respond to our confirmation email.

If we require further information from you in order to verify or process your request, or we need clarification about the nature of your request, we will contact you at the email you indicated below.

Submit the information below by email to ecommercemarketinggroupllc@gmail.com with the subject line: “CCPA”

1. Requestor information

Name:____________________________________________________

Email address:_____________________________________________

State of residence:__________________________________________

2. 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 have enclosed a California Authorized Agent Designation form completed and signed by the consumer.

3. Consumer information (if different from requestor)

Name:____________________________________________________

Email address:_____________________________________________

State of residence:__________________________________________

4. Request for online activity information

If your request applies to online activity information that Colloidal Silver Alternative may have collected through cookies or similar technologies, you must make your request from the browser or device that you have previously used to access Colloidal Silver Alternative’s websites or apps. This allows us to read any identifier that we have assigned to your browser or device.
5. Specify the request(s) — check all that apply

[ ] Request to know categories of personal information Colloidal Silver Alternative has collected, used, and or disclosed about the consumer.

[ ] Request to obtain specific pieces of personal information Colloidal Silver Alternative collected about the consumer.

[ ] Request to delete personal information Colloidal Silver Alternative has collected from the consumer.
Declaration

BY SIGNING BELOW, 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 AUTHORIZED BY THAT CONSUMER TO ACT ON HIS/HER BEHALF, AS INDICATED ABOVE. I UNDERSTAND THAT IT MAY BE NECESSARY FOR Colloidal Silver Alternative TO VERIFY THE IDENTITY OF THE CONSUMER AND/OR AUTHORIZED AGENT FOR THIS REQUEST, AND ADDITIONAL INFORMATION MAY BE REQUESTED FOR THIS PURPOSE

Signature:_______________________________________________________

Name:__________________________________________________________

Date:___________________________________________________________