CALIFORNIA CONSUMER PRIVACY RIGHTS REQUEST FORM

If you wish to exercise your rights over your personal information, please complete and submit this Consumer Privacy Rights Request Form to help Peruvian Connection respond to your request. If you desire to exercise your right to opt-out of the sale of your personal information, please complete our Do Not Sell or Share My Personal Information Opt-Out Form.

(1) Requesting Party:

Are you submitting this request:

On your own behalf?

As an Authorized Agent of a California resident?

(2) Information Concerning Subject of Consumer Privacy Rights Request:

Please provide the following information concerning yourself (or if you are an authorized agent, concerning the person on whose behalf you are submitting this privacy rights request form):

*Denotes required information. Other information requested will help us fulfill this Do Not Sell or Share request by enabling us to link the request to information we have about the person submitting the request (or on behalf of whom the request is submitted). Results will be limited to the information we can reasonably link to the requestor based on information provided on this form. The information you provide on this form will only be used for purposes of processing your request.

* First Name:

* Last Name:

Middle Name or Initial:

* Current Address Line 1:

Current Address Line 2:

* City:

* State of Residence:

* Zip/Postal Code

Current Email Address:

* Current Phone Number:

Customer Number:
(If available)

* Affirmation for Subject of Request: I affirm that I am a California resident.

(3) Information Concerning Authorized Agent (If applicable)

* First Name:

* Last Name:

Middle Name or Initial:

Business Name:
(Required if applicable)

Business Entity Number:
(Required if applicable)

* Email Address:

* Affirmation for Authorized Agents: I affirm that I am the Authorized Agent of a California resident.

(4) Subject Matter of Consumer Rights Request:

What are you requesting with respect to your personal information?

Right to know the categories of personal information we collect.

Right to know specific pieces of your personal information collected.

Right to request deletion of your personal information.

Right to request non-discrimination for exercising your rights under the CCPA.

Right to request correction of your personal information we maintain about you.

Right to opt-out of the sale of your personal information. Please complete our Do Not Sell or Share My Personal Information Opt-Out Form.

Other:

(5) Request Details (Include any details you think will assist us in responding to your request):

Peruvian Connection will confirm receipt of this information after you have submitted it for our review. In order to process some requests, further correspondence or verification of your identity may be required. This Form may be manually or electronically signed by any process that satisfies the California Uniform Electronic Transaction Act. For additional information about our privacy practices, view our U.S. Privacy Policy.

Attestation: I confirm under penalty of perjury that all information provided is true, accurate, and complete, and that it is my intention that this electronic request to exercise my right under the California Consumer Privacy Act shall carry the same force and effect as if I had manually signed this request. I further confirm under penalty of perjury that I am the person whose personal information is the subject of this request or, if I am an Authorized Agent, that the person for whom I am an Authorized Agent is the person whose personal information is the subject of this request.

You may submit your completed Consumer Rights Request form by demonstrating your intent to sign this form electronically either by (1) Emailing a signed copy to [email protected]; or (2) Clicking "submit" below.

CALIFORNIA CONSUMER PRIVACY RIGHTS REQUEST FORM

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