CALIFORNIA PRIVACY RIGHTS ONLINE REQUEST FORM

In order to exercise your Right to Know or your Right to Request Deletion, please complete the information below.  When you have completed the required information, submit the form by clicking “submit” at the bottom, or email the completed form to customerservice@deltagreekfoods.com.  After we receive the form, we will contact you to verify your information in order to process your request.

I           Complete the following information of the person whose information is the subject of this request:

_________________________                     _________________________

First Name                                                      Last Name

_________________________                     _________________________

Email Address                                                Phone Number

______________________________________________________________

Street address

_________________________         ______            _________________________

City                                                      State               Postal Code

II.         Request Type [check all that apply]

I REQUEST:

[  ] ACCESS TO SPECIFIC PIECES OF PERSONAL INFORMATION YOU HAVE ABOUT ME

[  ] ACCESS TO CATEGORIES OF PERSONAL INFORMATION YOU HAVE ABOUT ME

[  ] DELETION OF ALL MY INFORMATION

                        – or –

[  ] DELETION OF SPECIFIC PIECES OF MY INFORMATION AS DESCRIBED BELOW

III.        Additional Details

Please provide additional details in the space provided below:

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________