California Consumer Request Form

Please fill out this form and hit "SUBMIT" to send your request to Million Dollar Media for processing.
You may also print, complete and return this form via email to [email protected]
OR VIA U.S. MAIL TO:

Million Dollar Media, LLC
Attn: Law Department
1460 Route 9 North, Suite 201
Woodbridge, NJ
07095

NOTE: This form is intended only for consumers as defined under the California Consumer Privacy Act.
Consumers are natural persons who reside in California. Million Dollar Media will not respond to requests from any individuals who are not consumers or authorized agents as defined under the CCPA.

1. Requestor Details

Please provide the information requested below. Million Dollar Media will use the information you provide to verify your identity by matching it with any personal information we retain for you. As described in Section 5 below, you must provide a minimum of two (2) pieces of information, and maybe three (3), depending on the request, for Million Dollar Media to verify you. At a minimum, you must provide the information marked with an asterisk.

Title

Mr. Mrs. Ms. Other

First Name

Last Name:

Address:

Address 2:

City:

State:

Zip:

Birthdate:

Phone:

Email Address:

2. Are you the Requestor or Acting as Authorized Agent for the Requestor?

The term "Requestor" refers to the person about whom the information is being requested.

Yes, I am the requestor
If you are the Requestor, please read Section 3.

No, I am acting as an Authorized Agent for Requestor
If you are acting on behalf of the Requestor, please complete the form in Section 2.1.

2.1. Authorized Agent Details

Please provide the information requested below. You must, at a minimum, provide the information marked with an asterisk

Title

Mr. Mrs. Ms. Other

First Name

Last Name:

Address:

Address 2:

City:

State:

Zip:

Phone:

Email Address:

IF YOU ARE SERVING AS AN AUTHORIZED AGENT FOR A CALIFORNIA CONSUMER PLEASE EMAIL OR MAIL A WRITTEN STATEMENT, SIGNED BY THE CONSUMER, AUTHORIZING YOU TO SERVE AS THE CONSUMER'S AGENT FOR THE PURPOSES OF EXERCISING THE CONSUMER'S RIGHTS UNDER THE CCPA. IF YOU DO NOT PROVIDE THE SIGNED AUTHORIZATION, Million Dollar Media CANNOT HONOR ANY REQUEST YOU SUBMIT ON BEHALF OF A CONSUMER.

3. Request

Requestors can exercise three (3) different rights.

The first is a "Right to Know (Abbreviated Request)." This right entitles you to know the categories of personal information that Million Dollar Media has collected about you, the categories of sources from which PI was collected, the business or commercial purpose for which it collected the PI, the categories of third parties to whom the business sold or disclosed the PI for a business purpose, and the business or commercial purpose for which it sold or disclosed PI. This right covers the 12-month time period leading up to the date Million Dollar Media receives the request.

The second is a "Right to Know (Specific Pieces of Information)." This right entitles you to access the specific pieces of information (e.g., name, address, email address) that Million Dollar Media has collected about you. This right covers the 12-month time period leading up to the date Million Dollar Media receives the request.

The third is a "Right to Delete" request, which entitles you to the deletion of the personal information that Million Dollar Media retains about you.

Please check the relevant box to indicate the purpose of your request.

Right to Know (Abbreviated Right)

Right to Know (Specific Pieces of Information)

Right to Deletion

4. How We Use Your Personal Information to Verify You

The CCPA requires that businesses verify consumer requests to a reasonable degree or a reasonably high degree of certainty, depending on the nature of the request. We will use the information you provide in Section 1 above to verify you.
If you do not provide at least two (2) pieces of personal information that we are able to match to personal information we retain for you, we will not be able to honor a request to know (abbreviated request). If you do not provide at least three (3) pieces of personal information that we are able to match with personal information we retain for you, we will not be able to honor a request to know (specific pieces of information) or a request to delete. If we are unable to verify you, we will not be able to respond to fulfill your request. Million Dollar Media will provide you with written notice where we are unable to verify you.

5. How We Protect Your Information

Million Dollar Media uses reasonable data security controls to ensure that the information you provide to us in connection with this request is protected from unauthorized access. If Million Dollar Media has good faith reasons to believe that a request is fraudulent, we reserve the right to seek additional information to verify your request, or to deny the request.

6. How Long We Retain Information Relating to Your Request

We will retain the personal information you provide in this request form, as well as the personal information we provide to you in response to a verified right to know request only as long as necessary to assess and respond to your request.

7. Timing

You will receive an acknowledgment that Million Dollar Media has received your request by email or mail within ten (10) days. Million Dollar Media will provide a response to your request within 45 days after receiving the request. Million Dollar Media may take up to an additional 45 days, for a total of 90 days, if necessary, to respond to the request. You will be notified by mail or email if Million Dollar Media will need an additional 45 days to respond.

If Million Dollar Media declines to honor a request to know or delete, we will provide an explanation in writing, via mail or email, within the time-period set forth above. If Million Dollar Media intends to grant your request to delete, we will ask you to again verify that you wish for Million Dollar Media to delete your personal information. You will receive verification that Million Dollar Media has deleted your personal information within ten (10) days after your personal information has been deleted.