CCPA Consumer Rights Request Form

If you are a California resident, you have certain rights under the California Consumer Privacy Act (“CCPA”). Upon submission of a verifiable consumer request, you have the right to request that we provide disclosures about or access to, in a portable and (if technically feasible) readily usable form: the specific pieces and categories of personal information that we have collected about you in the past twelve (12) months (from the date of our receipt of the request); the categories of sources from which your personal information was collected; the categories of personal information we sold or shared about you and the categories of third parties to which each category of personal information was sold or shared; the categories of personal information we disclosed about you for a business purpose and the categories of persons to which the personal information was disclosed; and the business or commercial purposes for collecting, selling, or sharing your personal information. California residents also have the right to submit a request for deletion of their personal information under certain circumstances; and the right to correct inaccurate personal information.

California residents also have the right to opt out of the sale or sharing of their personal information via cookies and tracking technologies on our websites. To opt out of the sale or sharing of your personal information, click the “Do Not Sell or Share My Personal Information” button in the footer of our websites.

FIRST NAME*

MIDDLE NAME

LAST NAME*

SELECT ALL THAT APPLY*

Please describe your relationship to the York affiliate that collected your personal information:

If you are an authorized agent of a California resident and are making this request on his or her behalf, you will be required to provide a copy of the California resident’s written authorization (for example, a power of attorney) showing that you have been granted the authority to submit a consumer rights request on behalf of the California resident. For verification purposes, we will contact you at either the email address or mailing address you provide below so that you can provide us with a copy of the California resident’s written authorization. To the extent that the written authorization provided to us is insufficient, we will contact you for further verification at the contact information you provide below. We may also contact the California resident in order to verify his or her identity, and to confirm your authority to make a consumer rights request on his or her behalf, prior to responding directly to you.

Additional information needed to verify your identity for request processing

TODAY'S DATE*

Address

ADDRESS 1 ADDRESS 2 CITY STATE / PROVINCE POSTAL CODE

CONTRACT NUMBER (IF KNOWN)

DESCRIPTION/AMOUNT OF RECENT PURCHASE (IF KNOWN)

DATE OF RECENT PURCHASE (IF KNOWN)

CONTACT PHONE*

CONTACT EMAIL*

Please indicate how you would like to receive the information requested above by checking one of the following.

By Mail (at Address above)

By Email (at Email above)

ACKNOWLEDGEMENT*

I understand that I may make a verifiable consumer request twice within a twelve (12) month period. If I have submitted a request for deletion, I understand that, while I have the right to request deletion of my personal information, SCI or its affiliate may be able to retain some or all of the personal information for a variety of ‎reasons, such as to comply with a legal obligation.‎ I further understand that SCI or its affiliate will respond to my request as necessary using the information I provided above.