KYL CCPA Info Request

Keesal, Young & Logan

CCPA consumer information request

Notice at Collection of Personal Information: if you are submitting this request on behalf of yourself, we will collect your name, your e-mail address, your mailing address, your telephone number (if you choose to give it to us), and information about your relationship with us. If you are submitting this request on behalf of someone else or on behalf of the consumers in your household, we also will collect their names and information about their relationship with us. We collect this information in order to process and respond to your request. For our record keeping purposes, we will keep a copy of your request, our response and any documents you submit to us during this process. We are required to keep these records for a minimum of 24 months.

Are you submitting this request on your own behalf or on behalf of someone else?

on behalf of yourself

on behalf of someone else

Are you a resident of the United States?

Yes

No

Is the consumer a resident of the United States?

Yes

No

What would you like to do relative to your information? Values are not selected Press enter to open combobox or type to start search.

What would the consumer like to do relative to their information? Values are not selected Press enter to open combobox or type to start search.

What is your preferred method of correspondence in return

Email

US postal mail

YOUR INFORMATION

First Name

Last Name

Email Address

Full Mailing Address

Phone Number

CONSUMER INFORMATION

First Name of Consumer

Last Name of Consumer

Consumer Email Address

Consumer Mailing Address

Consumer Phone Number

RELATIONSHIP WITH The Company

What is your relationship with our company? Value is not selected Press enter to open combobox or type to start search.

What is the consumer's relationship with our company? Value is not selected Press enter to open combobox or type to start search.

What is the name of your primary contact at KYL?

What is the name of the consumer's primary contact at KYL?

Supporting Documentation

To submit a request on behalf of someone else, we require that you provide us with written permission from the consumer authorizing you to make this request. Please upload a copy of that written permission here.

Upload written permission from the Consumer related to this request

If you want to know the specific pieces of information that we have collected, we require that you submit a declaration signed under penalty of perjury that you are the consumer whose personal information is the subject of this request. Please upload a copy of your signed declaration here.

Upload a signed declaration under penalty of perjury confirming your identity related to this request

If the consumer wants to know the specific pieces of information that we have collected about them, we require that you submit a declaration signed under penalty of perjury that the consumer is the consumer whose personal information is the subject of this request. Please upload a copy of the consumer's signed declaration here.

Upload a signed declaration under penalty of perjury confirming the consumer's identity related to this request

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KYL Consumer Information Request Intake Only for Jan 1, 2020