California Consumer Privacy Act (“CCPA”) Personal Information Request Form

If you are a California resident, you may have the right to: (1) Request access to certain personal information we have collected about you. (2) Request that we delete certain personal information we have collected from you. (3) Opt-out of the sale of your personal information. To exercise any of these rights, please complete the relevant portion of the form below, including any applicable supplemental forms.

Certain provisions of the CCPA do not apply to personal information we receive from you reflecting a communication or transaction between us and another business when you are acting as an employee, owner, director, officer, or contractor of such company, partnership, sole proprietorship, nonprofit, or government agency and you are seeking a product or service from us for the company, partnership, sole proprietorship, nonprofit, or government agency (a "Business Consumer").

Right to Know/Access: You have the right to request access to the categories of information we have collected about you and the specific pieces of personal information that we have collected about you that is subject to the CCPA. This right does not apply to Business Consumers, current or former employees, and job applicants.

Right to Delete: You have the right to request deletion of certain personal information that we have collected from you. Please note that we will only delete information that is subject to the CCPA and will not be able to delete any personal information that is necessary or appropriate to provide our products or services or that are subject to certain exceptions as permitted by law. This right does not apply to Business Consumers, current or former employees, and job applicants.

Right to Opt-Out of Sale: You have the right to opt-out of sale of your personal information we collect on our websites, such as to provide personalized pages for visitors and provide assistance during the website visit.

Step 1: Please identify which privacy right(s) you would like to exercise

NOTE: Please be advised that we can only search for your information using the details that you provide. If you decline to provide information, our search may be incomplete. Proper authentication is critical to ensuring the protection of personal information. Depending on the response to your request, you may be required to provide proof of identity, such as a government-issued photo ID, before it can be fulfilled. We will respond to your request consistent with applicable laws. You are limited to two (2) requests within a twelve (12) month period.

Are you a California Resident?

 Yes
 No

What type of request is this?

 Request to Know/Access the categories of information we have collected about you
 Request to Know/Access specific pieces of personal information we have collected about you
 Request to Delete certain pieces of personal information we have collected from you

Step 2: Person Submitting the Request

Is this request for yourself or on behalf of someone else?

 Myself (“Consumer”)
 On behalf of someone else (“Authorized Agent”)

If you are making the request(s) as a Consumer, you must:

Consumer Information:

*First Name
*Last Name
*Date of Birth
(MM/DD/YYYY)
*Email Address
*Primary Telephone Number
(Include area code)
Other Telephone Number
(Include area code)
*Address Line 1
(Street address)
Address Line 2
Apartment, suite, floor, etc.
*City
*State
*Zip Code
Other Identifying Details we should search
IP address, Device ID, etc.
*Required Field

If you are making the request(s) as an Authorized Agent on behalf of a Consumer, you must:

NOTE: You may be contacted for evidence of your identity as well as that of the Consumer.

Authorized Agent Information:

*First Name
*Last Name
Legal Entity Name
DBA Name, if any
*Date of Birth
(MM/DD/YYYY)
*Email Address
*Primary Telephone Number
(Include area code)
Other Telephone Number
(Include area code)
*Address Line 1
(Street address)
Address Line 2
Apartment, suite, floor, etc.
*City
*State
*Zip Code
Other Identifying Details we should search
IP address, Device ID, etc.
*Required Field

Step 3: Please describe the nature of the Consumer’s interaction with Jeffersonvalleyfinance.com

 Existing Customer
 Previous Customer
 Current Employee
 Former Employee
 Job Applicant
 Consumer who visited our website
 Other

Step 4: Please select how you would like to receive our response

 By email to the email address provided above
 By mail to the address provided above

NOTE: If you are a Consumer submitting this request, we will email or mail the information provided in the Consumer Information section above. If you are an Authorized Agent submitting this request, we will email or mail the information provided in the Authorized Agent Information section above.