California Consumer Privacy Act Request

California Consumer Privacy Act Request
Name: *

First Name Last Name
I am a California resident: Yes or No *

Yes No
*Please note you must be a California resident to request information based on the California Consumer Privacy Act. No further action can be taken on this form. For more information about our Terms and Conditions or Privacy Policy, please click one of the following links.

- Our Terms and Conditions
- Privacy Policy
Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email: *
example@example.com
Phone Number

Area Code Phone Number
Type of Request

Access Request: Please send me a copy of the information that Hope4Cancer has collected about me in the last 12 months. Request to Know: Categories of personal information collected about me in the last 12 months. Request to Know: Categories of sources from which the personal information about me was collected. Request to Know: Business purpose for which Hope4Cancer uses the personal information collected about me. Request to Know: Categories of third parties with whom Hope4Cancer shares or has shared information collected about me in the last 12 months. Request for Deletion: Please delete all personal information that Hope4Cancer has collected from me. Request to Opt Out: I do not want my personal information sold. Please cease and refrain from selling my personal information.
This request has been submitted through an agent on my behalf:

Yes No
Agent's Name:

First Name Last Name
This agent has been authorized in writing to submit this request on my behalf:

Yes No
Please verify that you are human *
Should be Empty:

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