CCPA Request - Winemakers Selection

REQUESTER INFORMATION

*Name of Requester(Required)

*Email of Requester(Required)

*Phone Number of Requester(Required)

*City and State of Residence(Required)

SPECIFY TYPE OF REQUEST - CHECK ALL THAT APPLY

DECLARATION

BY CHECKING THE BOX BELOW, I HEREBY CERTIFY THAT THE INFORMATION ENTERED INTO THIS FORM IS COMPLETE, ACCURATE AND UP-TO-DATE, AND THAT I AM THE CONSUMER WHO IS THE SUBJECT OF THE REQUEST OR HAVE BEEN AUTHORIZED BY THAT CONSUMER TO ACT ON HIS/HER BEHALF, AS INDICATED ABOVE. I UNDERSTAND THAT IT MAY BE NECESSARY FOR YOU TO VERIFY THE IDENTITY OF THE CONSUMER AND/OR AUTHORIZED AGENT FOR THIS REQUEST, AND ADDITIONAL INFORMATION MAY BE REQUESTED FOR THIS PURPOSE

California Consumer Privacy Act

REQUESTER INFORMATION

SPECIFY TYPE OF REQUEST - CHECK ALL THAT APPLY

DECLARATION