CCPA Submission Form

Are you a natural person or entity registered with the California Secretary of State?
Yes (Please be prepared to provide documentation as proof upon request.)No

Are you a current or former customer of Synergy One or an affiliated company?
YesNo

Please provide the following information to verify your identity:

Full Name:
Address:
Phone:
Email address:

Which of the following consumer rights would you like to exercise:
Request a copy of the information we have collected, used, sold or disclosed about youOpt-out of the sale of your personal informationDelete in-scope information we have about you

How would you like to receive the response to your request(s)?
MailElectronic

If you are not registered with the California Secretary of State, you are not considered an authorized agent and therefore cannot make a CCPA request on behalf of another consumer.