CCPA form

1. Request information

Name*

Enter your name

Email*

Invalid email

City*

Enter your city

State*

Enter your state

2. Are you the consumer?*

Yes, I am making a request related to personal information about me.

No, I am acting as an authorized agent for the consumer. I have enclosed a California Authorized Agent Designation form completed and signed by the consumer.

3. Consumer information (if different from requestor)

Name*

Enter your name

Email*

Invalid email

City*

Enter user city

State*

Enter user state

4. Specify the request (s) — check all that apply*

Request to know the personal information Prisma AI has collected, used and/or disclosed about the consumer.

No, I am acting as an authorized agent for the consumer. I have enclosed a California Authorized Agent Designation form completed and signed by the consumer.

Request to delete personal information Prisma AI has collected from the consumer.

Request to opt-out of the sale or sharing of personal information.

Request not to be discriminated against if you choose to exercise any of the above rights.

7. Declaration

By signing below, i hereby certify that the information entered into this form is complete, accurate and up-to-date, and that i am the consumer who is the subject of the request or have been authorized by that consumer to act on his/her behalf, as indicated above. I understand that it may be necessary for prisma ai to verify the identity of the consumer and/or authorized agent for this request, and additional information may be requested for this purpose

Name*

Enter name

Date*

Enter date