This form is for California residents only. If you are not a California resident, please visit our privacy policy.

California residents may use this form to opt out of the sale, or sharing, of their personal information to third parties. While you are not required to complete all fields, please be advised that we can only search for your information and mark it as not to be shared using the details that you provide; if you decline to provide information, our search may be incomplete.

Please note that you do not have the right to opt out of our sharing your personal information with service providers, who are parties we engage to perform a function on our behalf and are contractually obligated to use the information only for that function.

If you are completing your request on behalf of another person, please fill in the consumer’s information and add your information in the space provided.

Consumer Name

Consumer Email

Consumer Mailing Address

Consumer Mobile Phone Number

Other Identifying Details We Should Search (IP Addresses, Device IDs, etc.)

Please describe the nature of Consumer’s relationship with CPK Media*

Customer/Subscriber

Other

Are you completing this request on behalf of another individual?*

Yes

If Yes, please provide your name, email address, mailing address, and phone number. Please attach documentation showing the Consumer’s authorization (if Consumer is over 18).

I am the legal parent/guardian and the Consumer is under 18. I have legal authority to act on behalf of this individual. I am duly authorized by the Secretary of State to submit requests on behalf of others, and the consumer has authorized me to act on their behalf.

No

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