CCRP

Consumer's Name*

Requester's Name*

Relationship Between Consumer and Requester (e.g., Self, Authorized Agent)*

Consumer’s Phone Number*

Consumer Address (including the state of residency)

Address Line 1*

Address Line 2

City*

Zip Code*

Consumer’s Relationship to Cumberland Farms (Including the Cumberland Farms Entity, Products and/or Services Relevant to the Request)*

Type of Request*

Right to Know: Right to confirm whether we are processing personal data about the consumer and to obtain certain personalized details about the personal data we have collected about the consumer.
Right to Access & Portability: Right to obtain access to the personal data collected about the consumer, and, where required by law, the right to obtain a copy of the personal data in a portable, and, to the extent technically feasible, readily usable for
Right to Correction: Right to correct inaccuracies in the consumer’s personal data, taking into account the nature of the personal data and the purposes of the processing.
Right to Control Over Sensitive Personal Data: The right to exercise control over our collection and processing of certain sensitive personal data.
Right to Control Over Automated Decision-Making / Profiling: The right to direct us not to use automated decision-making or profiling for certain purposes.
Right to Opt-Out of Sales: Right to direct us not to sell the consumer’s personal data to any third parties.
Right to Deletion: Right to have us delete personal data we collected about the consumer.

Right to Opt Out of the Selling or Sharing of Personal Data for Targeted Advertising Purposes

You may also have the right to opt out of the selling or sharing of your personal data for targeted advertising purposes. In California, this is also referred to as the right to opt-out of the sharing of your personal data for cross-contextual advertising purposes.

To exercise your Right to Opt-Out of the sale or sharing of your personal data to third parties for targeted or cross-context behavioral advertising purposes as it relates to the use of cookies and other tracking technologies:

• For browser-based opt-outs, please click the ”Do Not Sell or Share My Data” link in the footer of our website to opt-out of targeted advertising. Please note you must navigate to each website for which you wish to opt-out of targeted advertising and click on the relevant link in the footer to opt-out. This opt-out is browser specific, and you must reset your preferences if you clear cookies or use a different browser or device. if you are visiting one of our sites with the Global Privacy Control enabled, any cookies that constitute sales or are used for targeted advertising should already be turned off automatically in our cookie preference manager for that site.

• For app-based opt-outs, please visit the settings menu on your mobile device by selecting "limit ad tracking" (iOS) or "opt-out of interest-based ads" (Android).

Authorized Agents Only:

If you’re an Authorized Agent submitting a request on behalf of a consumer, you must attach written authorization from the consumer indicating you’ve been authorized to submit a request on the consumer’s behalf. The form must be signed by both you and the consumer. All forms not signed will be rejected.
Note:
You also have the right to appeal in the event that we decline to take action on a request exercising one of your rights set forth above, you have the right to appeal our decision.

Are you the consumer?*

Yes, I am making a request related to personal information about me.
No, I am acting as an authorized agent for the consumer. I have attached one of the following, completed and signed by the consumer: (1) a signed authorization of the consumer; or (2) a Power of Attorney pursuant to California Probate Code §§4121 to 4130

Requester’s Email Address*

Requester’s Phone Number*

Additional Comments (e.g., the scope of personal data involved)*

Attachment*

By submitting this request, I am confirming the following: Accuracy: The information I have provided is true and accurate; Privacy: I understand the information will be processed by Cumberland Farms and our family of companies in accordance with our Privacy Notice; Contact: Cumberland Farms and our family of companies have the right to contact me to verify my identity and to process this request.*

I accept.