CCPA - Verifiable Consumer Request Form | Homebridge Financial Services

Step 1 of 2

Are You a Resident of California (or making a request on behalf of a resident of California)?(Required)

Yes

Do you wish to make a Verifiable Consumer Request pursuant to the California Consumer Privacy Act of 2018 (CCPA)?(Required)

More information regarding your rights under the CCPA (if any) can be found here.

Yes

By completing and submitting the below form, you will submit information and follow procedures sufficient for a Verifiable Consumer Request pursuant to the CCPA.

I am making this request on behalf of:(Required)

I am a (an)(Required)

Select Request Type:(Required)

Name(Required)

First Last

Last 4 Digits of Your Loan Number(Required)

(If not applicable please insert "1111")

Your Telephone Number(Required)

Email(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Captcha

**California law permits California consumers to use an authorized agent to make privacy rights requests. We require the authorized agent to provide us with proof of the California consumer’s written permission (for example, power of attorney) that shows the authorized agent has the authority to submit a request for the California consumer. The authorized agent must also verify his/her own identify. We will confirm the agent’s authority with the California consumer about whom the request was made.

Name

This field is for validation purposes and should be left unchanged.

CCPA – Verifiable Consumer Request Form