CCPA Request Form 


(Request to Know, Request to Delete, Request to Correct, Request to Access ADMT, and Request to Appeal ADMT Decision)

CCPA Request Form

Are you a resident of California? If you marked “no” above, you do not have any rights under the CCPA and we will therefore not respond to this submission.
Are you a member with Rogue Credit Union? If you marked “no” above, you do not have any rights under the CCPA and we will therefore not respond to this submission.
If you marked “yes” above, please provide your membership number:
Do you have online banking with us? If you marked “no” above, you do not have any rights under the CCPA and we will therefore not respond to this submission.
If you marked “yes” above, have you shared your username and password with anyone else?
Are you our past or current employee?
Your E-mail Address or Consumer Authorized Agent (if Applicable)
Your E-mail Address or Consumer Authorized Agent (if Applicable)
If you marked “no” below, you do not have any rights under the CCPA and we will therefore not respond to this submission.
Type of Request
Request to Know (please check all that apply to your request):
Request to Delete Personal Information?
Request to Correct Personal Information?
Please attach any documents that you would like us to consider in support of your request for us to correct the contested personal information We may require additional documentation from you regarding the contested personal information. We may deny your request if we determine that the contested personal information is more likely than not accurate based on the totality of circumstances.
If for any reason we are unable to correct, would you like us to consider deleting the information instead?
Request to Access Automated Decision-Making Technology (ADMT)
Request to Appeal ADMT Decision

Note About Identity Verification:

We will need to verify your identity.  Within 10 business days of your submission of this form, we will notify you of what we will need to verify your identity.  

If you are an authorized agent for the above referenced consumer, we will request a copy of your government issued identification card, and written authorization from the consumer to submit the request.  Additional details will be provided to you regarding what we need to verify you and your request within 10 business days of your submission of this form.