CCPA form

Verified Consumer Request Form

To process Your Verified Consumer Request, we need some basic information from You. We will only use personal information provided to verify Your identity or authority to make the request, to locate the information within our systems and respond to Your request. We cannot respond to Your request if we cannot verify Your identity or authority to make the request and confirm that the personal information relates to You. 

For more information, please go to Privacy Notice and Disclosure for California Residents.

SECTION 1: Consumer
(note this address will also be used for correspondence relating to this request)
Please provide any additional information that might be helpful in fulfilling Your request regarding how you have engaged with Co-Parenter, LLC. For example, “I purchased a product last month.”
SECTION 2: Are you the Consumer who is the subject of this Request?
SECTION 3: Details of Authorized Agent

If this request is on the behalf of the Consumer, upload either a copy of a power of attorney provided by the Consumer pursuant to Probate Code sections 4121 to 4130 or proof of signed permission along with a copy of the Authorized Agent’s ID. If a power of attorney is not provided, the Consumer will be required to confirm with us directly that they provided permission to submit the request.

Max. file size: 120 MB.
SECTION 4: Nature of Request
Please select all desired options:
Please select all desired options:
SECTION 5: Delivery Options
The e-mail address you provided in Section 1 will be used for correspondence relating to this request. If you made a request to know specific pieces of information you can receive the information electronically or by mail. If you elect to receive the information by mail please provide your mailing address.
SECTION 6: Declaration

The following CCPA requests require you to submit a signed declaration under penalty of perjury that you are the consumer whose personal information is the subject of this request.

  • Right to Know – Specific Pieces of Personal Information 
  • Deletion Request 

Please complete the below declaration as required so that we may fulfill your request made pursuant to CCPA.

Declaration in Support of Verified Consumer Request
I. Choose Request Type:

I acknowledge that I am a California resident and the person making the request noted above, under the California Consumer Privacy Act. I acknowledge that I am making this request in good faith on behalf of myself.
I certify and declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

MM slash DD slash YYYY

Complete this form online or click here to download the form to submit via mail or email.

Drop files here or
Max. file size: 120 MB.

    If You choose not to upload this declaration directly You can send it to either:

    Mailing Address:

    2317 3rd Avenue North Suite 101 Birmingham, Alabama 35203

    Email Address:

    support@coparenter.com