CCPA Consumer Data Deletion & Opt-Out Rights Request Form
Full Legal Name
· · ·
Email Address on File
· · ·
Phone Number on File
· · ·
Submit
The CCPA Consumer Data Deletion & Opt-Out Rights Request Form is designed to help businesses comply with the California Consumer Privacy Act by providing California residents a clear, structured way to exercise their privacy rights. The form captures verified identity information, specifies the type of data request, and documents opt-out preferences for data sales and sharing.
This template is ideal for legal, compliance, and privacy teams at any company that collects personal data from California residents. It supports both direct consumer submissions and authorized agent requests, with fields for proof of authorization and detailed data locator information to streamline your internal review process.
Using this form helps ensure your organization meets the CCPA's strict requirements — including the 45-day response window — while reducing manual effort and maintaining an auditable record of all consumer requests. Customize it to match your data categories and internal workflows, and deploy it instantly on your website or privacy portal.
3Pages
19Questions
~6minTo complete
FreeNo credit card needed
Field types
Single Choice ×3
singlecheckbox ×3
Multiple Choice ×2
Full Name
Email
Phone
Address
Short Text
File Upload
Long Text
Yes / No
Dropdown
Signature
termsandconditions
Questions in this template
Free template
The exact questions included — customize any of them to fit your needs.
Page 1Consumer Identity Verification8 questions
Consumer Identity Verification
Under the California Consumer Privacy Act (CCPA), California residents have the right to request deletion of personal data and opt out of the sale or sharing of their information. Please complete this form to submit your request. We are required to verify your identity before processing.
1
Full Legal Name
*Full Name
2
Email Address on File
*Email
3
Phone Number on File
Phone
4
Residential Address
*Address
5
Are you a current or former California resident?
*Single Choice
6
Are you submitting this request on your own behalf or as an authorized agent?
*Single Choice
7
If authorized agent, please provide the consumer's full name
Short Text
8
Upload proof of authorization (e.g., signed letter, power of attorney) if submitting as an authorized agent
File Upload
Page 2Data Request Details5 questions
Data Request Details
1
What type of request are you submitting?
*Single Choice
Data Deletion Preferences
2
Which categories of personal data would you like deleted? (Select all that apply)
*Multiple Choice
3
Please provide any additional details to help us locate your data (e.g., account numbers, usernames, approximate dates of interaction)
Long Text
Opt-Out Preferences
4
Which opt-out rights would you like to exercise?
Multiple Choice
5
Would you like to opt out of all future data sales and sharing?
Yes / No
Page 3Acknowledgment & Submission6 questions
Acknowledgment & Consent
By submitting this form, you certify that the information provided is accurate and that you are the consumer whose personal data is the subject of this request, or that you are an authorized agent acting on behalf of that consumer. We will verify your identity and respond within 45 calendar days as required by the CCPA.
1
I certify under penalty of perjury that I am the consumer whose personal data is the subject of this request, or I am the authorized agent of that consumer.
*singlecheckbox
2
I understand that identity verification may be required before my request is processed, and that I may be contacted for further information.
*singlecheckbox
3
I acknowledge that deletion of my data may affect my ability to use certain services or features.
*singlecheckbox
4
How would you prefer to receive confirmation of your request?
*Dropdown
5
Digital Signature
*Signature
6
I have read and agree to the company's Privacy Policy and understand my rights under the California Consumer Privacy Act (CCPA).
*termsandconditions
How to use this template
Click "Use This Template Free" to open it in the FormBuilder editor. From there you can add, remove, or reorder fields with drag-and-drop, switch themes for instant restyling, add your logo, configure email notifications, and set your success message. When ready, publish with a unique link and start collecting responses immediately.
Ready-to-use structure — pre-configured fields out of the box
Applied "Umber" theme — fonts, colors, and layout already set
Mobile-responsive — works on every device without extra configuration
Fully editable with drag-and-drop — change anything in seconds
Free to use on any plan, no credit card required
Use this template
Free to use. Open in the editor, customize, and publish in minutes.
English
Español
Português
Русский
العربية
