Submission Form for Request to Know, Delete or Correct Personal Information

Name of Consumer:*

First NameLast Name

Date of Request:*

Date

If you are not the Consumer making the request but rather an authorized agent of the Consumer, please state your full name: First Name* Last Name* (References to “you” or “your” mean Consumer, not the Consumer’s authorized agent.)

Are you a resident of California?*

YesNo

If you marked “no” above, you do not have any rights under the CCPA and we will therefore not respond to this submission.

Are you a member with PostCity Financial Credit Union?*

YesNo

If you marked “yes” above, please provide your membership number:

Do you have online banking with us? *

YesNo

If you marked “yes” above, have you shared your username and password with anyone else? *

YesNo

Are you our past or current employee?*

YesNo

Consumer Email Address*

example@example.com

Authorized Agent Email Address

example@example.com

Consumer Phone Number*

Please enter a valid phone number.

Authorized Agent Phone Number

Please enter a valid phone number.

Consumer Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Authorized Agent Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

You authorize us to contact the Consumer and/or the Consumer’s authorized agent (if applicable) for identity verification purposes in accordance with our legal obligations.

Please select all of the following that apply to your request:

Type of Request:

1. Request to Know (please check all that apply to your request):*

The specific pieces of personal information we collected about you in a form that you can take with you (also called a “data portability request”).The categories of personal information we collected about you.The categories of sources for the personal information we collected about you.Our business or commercial purpose for collecting, sharing or selling that personal information.The categories of third parties to whom we disclosed, shared or sold your personal information.

2. Request to Delete Personal Information?*

YesNo

3. Request to Correct Personal Information*

YesNo

Please briefly describe what information needs to be corrected: *

Please submit any documents that you would like us to consider in support of your request for us to correct the contested personal information to member.services@postcitycu.org. We may require additional documentation from you regarding the contested personal information. We may deny your request if we determine that the contested personal information is more likely than not accurate based on the totality of circumstances.

If for any reason we are unable to correct, would you like us to consider deleting the information instead?*

YesNo

Note About Identity Verification:
We will need to verify your identity. Within 10 business days of your submission of this form, we will notify you of what we will need to verify your identity.

If you are an authorized agent for the above referenced consumer, we will request a copy of your government issued identification card, and written authorization from the consumer to submit the request. Additional details will be provided to you regarding what we need to verify you and your request within 10 business days of your submission of this form.

DECLARATION OF IDENTITY

I, First Name* Last Name* declare, under penalty of perjury under the laws of the State of California, that I am submitting this request in my capacity as the consumer or authorized agent on behalf of the consumer.

Signature*