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CCPA RequestNick Klausner2023-04-06T17:41:02+00:00

Submission Form for Request to Know, Delete, or Correct Personal Information

Are you a resident of California?(Required)
ONLY RESIDENTS OF CALIFORNIA ARE AFFORDED RIGHTS UNDER THE CCPA. NON-CALIFORNIA RESIDENTS ARE THEREFORE NOT ELIGIBLE TO COMPLETE THIS REQUEST.
MM slash DD slash YYYY
Are you the consumer making the request or an authorized agent of the consumer?(Required)
Consumer's Name(Required)
Consumer's Email(Required)
Consumer's Address(Required)
Authorized Agent's Name(Required)
Authorized Agent's Email(Required)
Authorized Agent's Address(Required)
Are you a customer of Centennial Lending?(Required)
Please do not include any spaces, dashes, or other special characters.
Are you a past or current employee of Centennial Lending?(Required)
Consent to Be Contacted(Required)
You authorize us to contact the Consumer and/or the Consumer’s authorized agent (if applicable) for identity verification purposes in accordance with our legal obligations.
Type of Request(Required)
Please select ALL that apply.
Is this a request to DELETE or CORRECT personal information?(Required)
Please submit any documents that you would like us to consider in support of your request for us to correct the contested personal information. We may require additional documentation from you regarding the contested personal information. We may deny your request if we determine that the contested personal information is more likely than not accurate based on the totality of circumstances.
Drop files here or
Max. file size: 2 GB.
    Would you like us to DELETE your personal information in the event we are unable to make the requested correction?(Required)
    Declaration of Identity(Required)
    NOTE ABOUT IDENTITY VERIFICATOIN:
    We will need to verify your identity. Within 10 business days of your submission of this form, we will notify you of what we will need to verify your identity.
    If you are an authorized agent for the above referenced consumer, we will request a copy of your government issued identification card, and written authorization from the consumer to submit the request. Additional details will be provided to you regarding what we need to verify you and your request within 10 business days of your submission of this form.
    Re-enter Name for Identity Declaration(Required)
    Clear Signature

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