CCPA Data Management Request - AMS Agent Management System

If you are a California resident and would like to exercise your rights under the CCPA, please fill out the form below. We may request additional information from you to verify that you are a consumer about whom we have collected personal information.

Please note that we will retain any information as required by local, state, and federal law as well as FCC/USAC Lifeline regulatory compliance. Contact us for more information.

Account Holder Full Name*

First NameLast Name

Your Current/Previous SafetyNet Phone Number*

Area CodePhone Number

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email*

example@example.com

Date of Birth*

Used to Validate Your Identity Only

Last 4 Digits of Social Security#*

Used to Validate Your Identity Only

I would like to request:*

Information about categories of personal information collectedAccess to specific pieces of personal informationDeletion of personal informationThat you do not sell my personal information

Details or Notes About Your Request

By signing below, you acknowledge that the information you submitted is true and accurate. You also understand that if the information you provide does not match the information in our system in its entirety, we will be unable to honor your request. Additionally, you also understand that your request will not be fulfilled unless we are able to accurately validate your identity by matching your date of birth and the last 4 of your social security number.

Signature*

I attest under penalty of perjury that I am the person, or an authorized representative of the person, making a CCPA request. I agree to receive emails or telephone calls to verify my identity so that SafetyNet Wireless can complete my request.”

Please verify that you are human*