CCPA - Verifiable Consumer Request Form | Homebridge Financial Services

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

No
Yes

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

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

No
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:*

I am a (an)*

Select Request Type:*

Name*

First Last

Last 4 Digits of Your Loan Number*

(If not applicable please insert "1111")

Your Telephone Number*

Email*

Address*

Street Address Address Line 2 City State ZIP Code

Declaration*

I declare under penalty of perjury that the foregoing is true and correct and I am the consumer (or his/her Authorized Agent) whose personal information is subject to this request.

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.

CCPA – Verifiable Consumer Request Form