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CCPA Request Form

First Name

Last Name

State

Phone

Relationship to AgWest Farm Credit (select all that apply)

Customer
Former Customer
Current Employee
Former Employee
Designated Representative of a California Resident
No Relationship
Other: Please identify your relationship to AgWest in the "other box below" (i.e., visitor to website, conference attendee, etc).

Other

Reason for contacting AgWest (Select all that apply)

Select a choice

I want to know how AgWest collects, uses and shares or discloses the personal information of California consumers

I want to know what AgWest may have collected about me (select all that apply)

The categories of personal information collected about me
The categories of sources from which personal information about me has been collected
The business purposes for collecting or sharing personal information about me
The categories of my personal information that AgWest shares for business purposes
The categories of third parties with whom AgWest shares my personal information
I want to know what specific information AgWest has collected about me

Select a choice

I want my personal information deleted or corrected