Your contact information
*First Name
*Last Name
*Email Address
*Mailing address
*State of residence
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Prove Your Identity
Option 1
If an individual is exercising right on his/her behalf, please follow the following procedure to verify your identity by responding to CCPA Form confirmation of receipt email.
Option 2
If an individual is designating another to exercise CCPA rights on his/her behalf, the individual essentially needs to present a power of attorney compliant with CA’s probate code that identifies that individual has been authorized by the requestor to act on his/her behalf. A power of attorney is legally sufficient if all of the following requirements are satisfied:
(a) The power of attorney contains the date of its execution.
(b) The power of attorney is signed either (1) by the principal or (2) in the principal’s name by another adult in the principal’s presence and at the principal’s direction.
(c) The power of attorney is either (1) acknowledged before a notary public or (2) signed by at least two witnesses who satisfy the requirements of California Probate Section 4122.
*Please select one of the two options below submit the required documentation by emailing us at
privacy@ctd.ai
:
Option 1
Option 2
Choose a Request Type
*What type of request would you like to make?
Obtain an explanation on how we collect, used and shared your personal information from the past 12 months
Obtain a copy of your personal information from the past 12 months
Delete my account (personal information we collected from you)
Please let us know if there are any details about your request that may help us fulfil it :
Request Frequency
*Have you made any similar requests to CTD in the last 12 months?
Yes
No
“By submitting this request I certify that I am a California resident.”
Thank you for your request
In the case of additional questions, please contact us at: example@ctd.ai or directly at: (0800) - XXX- YYYY
Oops! Something went wrong while submitting the form.
Terms of Use Agreement
Privacy Policy
©2021 Connect the Dots
Your contact information
*First Name
*Last Name
*Legal name of your Company (if you are acting on behalf of the company)
*Email Address
*Mailing address
*State of residence
First Choice
Second Choice
Third Choice
Contact information for the consumer on whose behalf you are making the CCPA request:Your contact information
*First Name
*Last Name
*Email Address
*Mailing address
*State of residence
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Your relationship to the consumer on whose behalf you are making the CCPA request:
Legal counsel
Power of attorney
Other authorized agent
Prove Your Identity
Option 1
If an individual is exercising right on his/her behalf, please follow the following procedure to verify your identity by responding to CCPA Form confirmation of receipt email.
Option 2
If an individual is designating another to exercise CCPA rights on his/her behalf, the individual essentially needs to present a power of attorney compliant with CA’s probate code that identifies that individual has been authorized by the requestor to act on his/her behalf. A power of attorney is legally sufficient if all of the following requirements are satisfied:
(a) The power of attorney contains the date of its execution.
(b) The power of attorney is signed either (1) by the principal or (2) in the principal’s name by another adult in the principal’s presence and at the principal’s direction.
(c) The power of attorney is either (1) acknowledged before a notary public or (2) signed by at least two witnesses who satisfy the requirements of California Probate Section 4122.
*Please select one of the two options below submit the required documentation by emailing us at
privacy@ctd.ai
:
Option 1
Option 2
Choose a Request Type
*What type of request would you like to make?
Obtain an explanation on how we collect, used and shared your personal information from the past 12 months
Obtain a copy of your personal information from the past 12 months
Delete my account (personal information we collected from you)
Please let us know if there are any details about your request that may help us fulfil it :
Request Frequency
*Have you made any similar requests to CTD in the last 12 months?
Yes
No
“By submitting this request I certify that I am a California resident.”
Thank you for your request
In the case of additional questions, please contact us at: example@ctd.ai or directly at: (0800) - XXX- YYYY
Oops! Something went wrong while submitting the form.
Terms of Use Agreement
Privacy Policy
©2021 Connect the Dots