GCFS, Inc.
California Consumer Privacy Act Request Web Form
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By submitting this Request Form to you, GCFS, Inc. (“GCFS”), I certify that I am a California resident who wishes to exercise my rights to make a request under the California Consumer Privacy Act (CCPA). I understand that GCFS is required to keep a record of my request for at least 24 months, including any ticket number assigned to my request, the request date and nature of the request, the manner in which the request was made, the date and nature of your response, and the basis for the denial of the request if the request is denied in whole or in part.
REQUESTOR’S CONTACT INFORMATION
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I understand that GCFS’s response(s) to my request will be in writing and I authorize you to provide your response(s), send verification of receipt of my request, or contact me in connection with my request, using the following contact information and method(s) of delivery:
VERIFICATION INFORMATION
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I understand that GCFS needs to be reasonably sure that I am making this request regarding my own information, or that I am authorized to make a request about someone else’s information. Therefore, I am providing the information below, which is accurate to the best of my knowledge, for purposes of allowing you to attempt to verify my request. I understand that you will use the verification data provided to cross-check information available in your records to the extent possible, and that you may contact me to request additional information and/or deny my request if the information provided is insufficient for purposes of verification. (Check appropriate box and provide associated verification information as applicable):
I am making this request:
If requesting information regarding my own personal information. If this section does not apply, simply type N/A/ in the field:
AND (You must submit one of the following)
If requesting information or action regarding my minor child or a minor child for whom I serve as a legal guardian. By filling in this information, I confirm that I am authorized to provide, and do hereby provide, consent for you to take action regarding and/or release to me information regarding the minor child. If this section does not apply, simply type N/A/ in the field.
We will contact you with instructions to submit proof of parentage or guardianship. Acceptable forms of proof include a birth certificate or relevant court document establishing status with respect to minor child.
I am make this request in my capacity as a designated and authorized individual seeking information or action regarding another person. By filling in this information, I confirm that I am authorized to do so. If this section does not apply, simply type N/A/ in the field.
AND (You must submit one of the following)
We will contact you with instructions to submit proof of your authorized status. Acceptable forms of proof include a Power of Attorney, an authorization sworn and signed under penalty of perjury or other legal document establishing your authority, or proof of registration with the California Secretary of State as a representative authorized to act for another consumer. Alternatively, the consumer whose information is at issue may contact us directly, using the ticket number you will receive in response to this request, to verify his/her identity and then provide us written permission authorizing you to act for him/her.
NATURE OF REQUEST
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The nature of my request is as follows, and I understand that I am only permitted to make a verifiable consumer Request to Know or Request to Access regarding my data under the CCPA twice in any 12-month period. (Check appropriate box and provide associated information as applicable).
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The categories of Personal Information you have collected about me;
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The categories of sources from which that Personal Information has been collected;
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The categories of Personal Information collected about me that have been sold or disclosed to others for a business purpose; and
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The categories of Third Parties to whom the Personal Information collected about me has been sold or disclosed for a business purpose.
I would like to receive a copy of the Personal Information collected about me for the past 12 months. Unless otherwise noted here, I would like to receive copies of all such information. I am aware that certain information will not be disclosed to me, even if my CCPA request is verified, such as my social security number, driver’s license number, and bank account information. I am also aware that you are not required to disclose specific pieces of personal information to me, as opposed to categories, unless I provide to you a written declaration under penalty of perjury stating that I am the consumer whose personal information is the subject of this request.
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Optional Restriction: I would only like to receive copies of the following Personal Information/Categories of Personal Information from your records:
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We will contact you with instructions to submit proof of your identity before we can disclose specific pieces of Personal Information that we may maintain. We require a Declaration, under Penalty of Perjury, confirming you are the consumer whose personal information is at issue.
I would like the Personal Information collected about me to be deleted. Unless otherwise noted here, I would like you to delete all such information.
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Optional Restriction: I would only like you to delete the following Personal Information/Categories of Personal Information from your records:
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GCFS does not Sell Personal Information to Third Parties, as those terms are used in the CCPA, which is why there is no option to submit a request to opt out of such sales.
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If you have any questions about this form or your CCPA rights, you may contact us at 877-348-2009 or CCPA@GCFSinc.com. Our Privacy Policy is also available online, at [insert hyperlink to privacy policy].
