California Consumer Privacy Act (CCPA) Request Form

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California residents may make requests for the personal information collected and held by Transpo Assist by submitting this request form to Transpo Assist Compliance by email at privacy@transpoassist.com . Please select the type of request you wish to make and provide us with information to aid us in verifying your identity.

Is your primary residence in the state of California? *

Yes

I am a (an): *

Consumer

Prospective Consumer

Transpo Assist Employee

Employee of a Transpo Assist Consumer

Other

Specify below *

Your Details:

First Name *

Last Name *

Email *

California Mailing Address *

Your request *

Know the categories of personal information that Transpo Assist has collected, used, and or disclosed about you;

Obtain the specific pieces of personal information that Transpo Assist collected about you;

Delete the personal information that Transpo Assist has collected from you; or

Do not sell the personal information that Transpo Assist has collected from you

Please explain your request:

By submitting this form, I hereby certify that the information entered in this form is complete, accurate, and up-to-date and that I am the consumer who is the subject of the request or has been authorized by that consumer to act on his/her behalf, as indicated above. I understand that it may be necessary for Transpo Assist to verify the identity of the consumer and/or authorized agent for this request, and additional information may be requested for this purpose.

Signature

Name *

Date *