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CCPA Data Request · Featured

Streamline CCPA Data Requests with Confidence

Enable California residents to submit verified CCPA data access, deletion, or opt-out requests quickly and compliantly with this ready-to-use form.

Use This Template Free Preview

Cloud theme

formbuilder.ai/f/california-consumer-privacy-act-ccpa-personal-data-access-deletion-request-form

California Consumer Privacy Act (CCPA) Personal Data Access & Deletion Request Form

Full Legal Name

· · ·

Email Address Associated with Yo

· · ·

Phone Number on File

· · ·

Submit

The California Consumer Privacy Act (CCPA) Personal Data Access & Deletion Request Form gives businesses a structured, legally compliant way to collect and process data rights requests from California residents. The form covers identity verification, request type selection, and a formal declaration—ensuring every submission meets CCPA requirements before processing begins.

This template is ideal for compliance officers, legal teams, customer service departments, and any organization that collects personal data from California consumers. It supports requests for data access, deletion, and opt-out of sale, and accommodates authorized agents submitting on behalf of consumers, complete with a power-of-attorney upload field.

By using this pre-built form, your organization can reduce manual intake errors, demonstrate good-faith compliance, and respond to verified requests within the 45-day statutory window. Customize the fields to match your internal workflows, branding, and data categories—then deploy instantly to your website or privacy portal.

3 Pages

19 Questions

~6min To complete

Free No credit card needed

Field types singlecheckbox ×3 Date ×2 Single Choice ×2 Dropdown ×2 Full Name Email Phone Address Short Text File Upload Multiple Choice Long Text termsandconditions Signature

Questions in this template

Free template

The exact questions included — customize any of them to fit your needs.

Page 1 Requestor Identity Verification 8 questions

Personal Information for Identity Verification

Under the California Consumer Privacy Act (CCPA), California residents have the right to request access to, deletion of, or opt-out of the sale of their personal information. Please complete this form to submit your request. We are required to verify your identity before processing any request.

1 Full Legal Name * Full Name

2 Email Address Associated with Your Account * Email

3 Phone Number on File Phone

4 California Residential Address * Address

5 Account Number or Customer ID (if applicable) Short Text

6 Date of Birth (for identity verification) * Date

7 Are you submitting this request on behalf of yourself or another person? * Single Choice

8 If submitting as an authorized agent, please upload written authorization or power of attorney File Upload

Page 2 Data Request Details 5 questions

Type of CCPA Request

1 Select the type of request you are submitting * Single Choice

Request Scope

2 Which categories of personal data does your request cover? * Multiple Choice

3 Preferred timeframe for the data you are requesting * Dropdown

4 How would you like to receive your data (if applicable)? * Dropdown

5 Additional details or specific information related to your request Long Text

Page 3 Verification & Consent 6 questions

Declaration & Authorization

By submitting this form, you confirm that the information provided is accurate and that you are a California resident or an authorized agent acting on behalf of a California resident. False or fraudulent requests may be subject to legal penalties. We will respond to verified requests within 45 calendar days as required by the CCPA.

1 I declare under penalty of perjury that I am the consumer whose personal information is the subject of this request, or I am an authorized agent submitting on behalf of the consumer * singlecheckbox

2 I understand that my identity must be verified before my request can be processed, and I may be contacted for additional verification * singlecheckbox

3 I acknowledge that this request will be processed in accordance with the California Consumer Privacy Act (Cal. Civ. Code §1798.100 et seq.) and the company's privacy policy * singlecheckbox

4 I have read and agree to the Privacy Policy and Terms of Service governing this data request * termsandconditions

5 Digital Signature * Signature

6 Date of Submission * Date

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.