California Consumer Privacy Act Requests Web Form

This page contains a webform for California residents to submit requests pursuant to the California Consumer Privacy Act (“CCPA”) to Great Lakes List Management(“Great Lakes List Management,” “we,” “our,” “us”).

Please indicate which request(s) you would like to make [insert checkboxes or a radio button indicating type of request].  More information about these rights is located [below/in our Privacy Statement]:

















In certain circumstances, we may request different or additional information than that noted above. We will contact you if this is needed.


Note: If you are making a Specific Pieces Request, you must submit a signed declaration including the following language:


Declaration of Consumer


I, [full name of consumer], a resident of California, in connection with my request to receive the specific personal information collected about me (the “Request”) by Great Lakes List Management, do hereby declare, under penalty of perjury under the laws of California and the United States, that I am the consumer whose personal information is the subject of the Request.


This Declaration is made this [date] day of [month], [year].
____________________________
[signature]

Definitions

Authorized Agents:  If you are acting as an authorized agent, we require you to provide a signed, written authorization to you by the consumer and may seek to independently verify the identity of the consumer you represent. Alternatively, we will accept a legal Power of Attorney under the California Probate Code to the authorized agent.  Authorized agents may use the form above to upload documentation demonstrating the agent has authority to exercise rights on the requesting consumer’s behalf.  If you are making a request on behalf of a minor under 13, we will require evidence of parental responsibility.


Household Requests: If you intend to make a request on behalf of a household, please indicate this in the “Other Information” section above. We are required to independently verify the identity of each member of the household.