Make a CCPA Request

CALIFORNIA CONSUMER PRIVACY ACT REQUEST FORM

The California Consumer Privacy Act (CCPA) provides California Consumers with rights regarding personal information, like the right to make Requests to Know and Requests to Delete. To make a request, please fill this form out completely and we will confirm receipt within ten (10) calendar days of your submission. We may need further verification of your identity or clarification of your request before responding. Personal information provided on this form won’t be used except to respond to your CCPA request. For details on your rights under the CCPA, how requests work, and how we respond, please visit our privacy policy at https://www.oliversmarket.com/privacy-policy/.

Requester Information

Name of Requester

Email of Requester

City and State of Residence of Requester

SPECIFY TYPE OF REQUEST – CHECK ALL THAT APPLY:

Request to delete some personal information Oliver's Market has collected on me

Request to delete all personal information Oliver's Market has collected on me

Request for access to all personal information Oliver's Market has collected on me

Request for access to categories of personal information

Specify Information for Deletion (Optional)

Additional Information (Optional)

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 OLIVER’S MARKET TO VERIFY THE IDENTITY OF THE CONSUMER AND/OR AUTHORIZED AGENT FOR THIS REQUEST, AND ADDITIONAL INFORMATION MAY BE REQUESTED FOR THIS PURPOSE

Signature

Printed Name

Date

CALIFORNIA CONSUMER PRIVACY ACT REQUEST FORM

Requester Information

Declaration

4 Locations to Serve Sonoma County

Cotati

Montecito

Stony Point

Windsor