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CCPA Request Form

California Consumer Privacy Act Request Form

If you are a California resident and would like to exercise your rights under the CCPA, please fill out and submit the form below, or call us at 1-800-679-4420.

  • Please fill out the following information about the person this request relates to:
First Name*
Last Name*
Email Address*
Phone Number*
Address
City/Town*
Zip Code*
  • CA Residence Attestation: Do you confirm that the person this request pertains to has a primary residence in the state of California?*
  • Please state the consumer's relationship to BankFive*:




  • Specify the request (please check all that apply)*


  • Are you making this request on behalf of someone else?*

  • If you are requesting on the behalf of someone else, you must upload a completed and signed California Authorized Agent Designation form (must be in .pdf format):