CCPA Request Form

Request to Know or Delete Personal Information.

If you are a California resident and would like to exercise your rights under the California Consumer Privacy Act, please fill out and submit the form below, or call us toll-free at 1-855-552-2655.

*indicates a required field

Please fill out the following information about the person this request relates to:

First Name*
Last Name*
Email Address*
Phone Number*
Address*
City/Town*
Zip Code*
Do you confirm that the person this request pertains to has a primary residence in the state of California?*

Please state the consumer's relationship to Bank5 Connect*:





Specify the request (please check all that apply)*



Are you making this request on behalf of someone else?*


If you are requesting on the behalf of someone else, you must upload a completed and signed California Authorized Agent Designation form (must be in .pdf format):

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