CCPA | Golden Valley Bank

California Consumer Privacy Request Form

To submit a request under the California Consumer Privacy Act please complete and submit this form and we will respond as soon as possible.

Name

This field is for validation purposes and should be left unchanged.

Name(Required)

First Middle Last

Email(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Tell us about your relationship with Golden Valley Bank(Required)

Select the Right You Want to Exercise(Required)

I am submitting this information on behalf of(Required)

Authorized Agent Name

As stated in our CCPA Policy; You will need to provide written authorization from the individual on whose behalf you are making the request that confirms you have the authority to make a request. We will be following up with the customer on whose behalf you are requesting the information for verification purposes.

Acknowledgement(Required)

By submitting this form I confirm I am a resident of California and that the information I have provided is true and accurate.