CCPA Request Webform

California residents can use this webform to submit requests under the California Consumer Privacy Act (CCPA) regarding personal information collected by the operators of the InsuredNation website (“InsuredNation”, “we,” or “us”) that is subject to the CCPA. If you are a California resident and would like to know about or obtain the personal information we maintain about you, would like to request that we delete your information, or would like to opt out of our sale(s) of your information, you may send a request by filling out the webform below or by sending an email to info@emailagency.com You will first be required to verify your identity as required by the CCPA and as set forth in our Privacy Policy to California Residents. If you are an authorized agent acting on behalf of a consumer, please submit a written, signed permission from the consumer to info@emailagency.com as proof of your authorization.

First Name*

Last Name

Email Address

Phone Number*

Zip Code

I Would Like to Submit the Following Request

Are you the customer?

Yes, I am making a request related to personal information about me.

No, I am acting as an authorized agent for the consumer. I understand that the request cannot be processed without a California Authorized Agent Designation form completed and signed by the consumer.

CAPTCHA

By clicking “Submit,” I confirm that the information I have provided is true and accurate, and I am the individual whose name appears above and to whom the personal information that is the subject of this request relates or that I am legally authorized by that individual to submit this request. I understand that I may be contacted regarding this request.