Simplify CCPA Right to Know Requests for Your Store

Give California shoppers a simple way to request the personal data your online store holds, with identity and agent verification built in.

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formbuilder.ai/f/e-commerce-customer-ccpa-right-to-know-personal-information-access-request-form

E-Commerce Customer CCPA Right to Know & Personal Information Access Request Form

I am submitting this request as

Consumer's Full Name

· · ·

Consumer's Email Address on File

· · ·

Submit

This E-Commerce CCPA Right to Know Request Form gives your online store a clear, structured way to receive consumer requests to access personal information under the California Consumer Privacy Act. Customers, or authorized agents acting on their behalf, can confirm California residency, specify what they are requesting and which types of personal information they want to know about, choose the time period covered, and select a preferred delivery method for your response.

Built for e-commerce brands, online retailers, and privacy teams, the template simplifies identity verification by asking for details a genuine customer is likely to know, such as the email address on file, a recent order number, and the total of their most recent purchase. Shoppers can also list other email or shipping addresses they have used, helping you locate every record. Agent-only fields capture the agent's name and email and allow a signed permission letter or power of attorney to be uploaded, while a declaration under penalty of perjury adds another layer of assurance before any data is disclosed.

Using a dedicated form instead of scattered emails helps you log every request in one place, track the 45-day response window, and keep an organized record of how each one was handled. Customize the wording, branding, and request options to match your privacy policy, embed it on your privacy page or account dashboard, and start handling Right to Know requests consistently and with confidence.

3 Pages

19 Questions

~6min To complete

Free No credit card needed

Field types Single Choice ×4 Full Name ×2 Email ×2 Multiple Choice ×2 Address Yes / No Short Text currency File Upload Long Text termsandconditions Date Signature

Questions in this template

Free template

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

Page 1 Requester & Consumer Information 5 questions

Requester & Consumer Information

1 I am submitting this request as * Single Choice

2 Consumer's Full Name * Full Name

3 Consumer's Email Address on File With Our Store * Email

4 Consumer's Residential Address * Address

5 Is the consumer a current California resident? * Yes / No

Page 2 Account Verification & Agent Authorization 6 questions

Account Verification & Agent Authorization

1 How has the consumer interacted with our store? * Multiple Choice

2 Order Number From Any Recent Purchase Short Text

3 Total Amount of the Most Recent Order currency

4 Authorized Agent's Full Name (agents only) Full Name

5 Authorized Agent's Email Address (agents only) Email

6 Signed Permission Letter or Power of Attorney (agents only) File Upload

Page 3 Request Details & Declaration 8 questions

Request Details & Declaration

1 What are you requesting? * Single Choice

2 Which types of personal information do you want to know about? * Multiple Choice

3 Time Period Covered by This Request * Single Choice

4 Preferred Delivery Method * Single Choice

5 Additional Details or Other Email and Shipping Addresses Used With Our Store Long Text

6 I declare under penalty of perjury under the laws of the State of California that I am the consumer whose personal information is the subject of this request or an authorized agent acting on the consumer's behalf, and that the information provided in this form is true and correct. I understand this information will be used only to verify identity and process this request. * termsandconditions

7 Date Signed * Date

8 Signature of Consumer or Authorized Agent * Signature

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.