California Consumer Privacy Act Request

First Name

Last Name

InterWest Client Policy Number

I am a California resident

Yes

I am a…

Consumer

Applicant, Employee, or Former Employee

Address

Address Line 2

City

State

Zip Code

Phone Number

Please send me a copy of the information InterWest has collected about me in the last twelve months.

Categories of personal information collected about me in the last twelve months.
Categories of sources from which the personal information about me was collected.
Business purpose for which InterWest collected about me.
Categories of third parties with whom InterWest shares or has shared the personal information collected about me in the last twelve months.

Please correct my personal information.

Please delete all personal information that InterWest collected from me.

This request has been submitted through an agent on my behalf

Yes

This agent has been authorized in writing to submit this request on my behalf

Yes

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