California Consumer Personal Data Request Form

Are you a California resident? *
YesNo

First Name*

Middle Name

Last Name*

If you are not the Consumer making the request but rather an authorized agent of the Consumer, please state your full name:

References to "you" or "your" mean Consumer, not the Consumer’s authorized agent.

Authorized Agent Full Name:

Are you a MUSA Auto Finance customer? *
YesNo

Are you either the Consumer or the Authorized Agent? *
YesNo

*You authorize us to contact the Consumer and/or the Consumer’s authorized agent (if applicable) for identity verification purposes in accordance with our legal obligations.

Please select all of the following that apply to your request:

Type of Request:

1) Request to Know (please check all that apply to your request):
Categories of Personal InformationCategories of Sources of CollectionBusiness or Commercial Purpose for Collecting or Selling InformationCategories of Third Parties with Whom Information is SharedSpecific Pieces of Information

2) Does your request include household information?
YesNo

3) Request to Delete Personal Information?
YesNo

If you are an authorized agent for the above referenced consumer, we will request a copy of your government issued identification card, and the source of your authority to act on behalf of the consumer (e.g., POA, letters of conservatorship, written instructions, etc.). Additional details will be provided to you regarding what we need to verify you and your request within 10-days of your submission of this form.

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California Consumer Personal Data Request Form