CALIFORNIA CONSUMER PRIVACY ACT DATA PRIVACY REQUEST

To submit an Access, Correction, or Do not Sell or Share Sensitive Personal Information request, please complete the following secure form or call us at 888-980-6091. Requests must be made by or on behalf of a California resident or an individual who resided in California in the last 12 months.

Request Type

Please select the type of request you would like to make.

Access

I would like to know what information you have about me.

Do not sell or share

Do not sell or share my personal information.

Delete

Remove data you have about me.

Correct

Correct personal information you have about me.

Limit use

Limit the use of sensitive personal information.

Please select a request type.

Requester Information

Are you making this request for someone else? Yes No

Authorized Agent Information

Please provide your contact information. For requests to access or delete data, you must submit proof that you have been authorized by the Requester to act on their behalf.

First Name

Last Name

Phone Number

Email Address

0/100

Requester Details

First Name

Middle Name (optional)

Last Name

Suffix (optional)

Date of Birth

Contact Information

Address Line 1

Address Line 2 (optional)

City

State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY

Zip Code

Phone Number

Email Address

CSAA Insurance Group Relationship

Select One... Employee Former Employee Employee Related Person (Spouse, Beneficiary, Dependent) Contractor Former Contractor Club or Independent Agency Employee/Contractor Job Applicant Website Visitor Policyholder Quote Requester Involved in a claim with a AAA Insurance policyholder AAA Member without AAA Insurance Other Role (Vendor, Office Visitor etc.)

Identification Details

Employee ID

Last 4 of SSN

Employee ID

Last 4 of SSN

Last 4 of SSN

Network (GID)

Employee ID (6 Digit Numeric)

Network (GID)

Employee ID (6 Digit Numeric)

National Producer Number (NPN)

Agent ID (6 Digit Numeric)

Last 4 of SSN

Job Posting Title

Policy Number

Quote Number

Claim Number

Membership Number

0/100

To process your request to access or delete data, we must be able to verify your identity by matching at least one of the above data points. If we cannot verify your identity, we will not be able to process your request.

Please complete the challenge.

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