Access & Deletion Rights Request Form – Northeast National Brokerage, LLC

California Consumer Privacy Act of 2018 (CCPA) - Access and Deletion Rights Request Form

If you are a California resident, subject to certain limitations under applicable law, you may have the right to request (1) access to Personal Information we have collected about you and (2) that we delete Personal Information we have collected from you. To exercise these rights, please complete this form. If you would like to submit a request as an authorized agent on behalf of another individual, please email legal@northeastnational.com. References to “us”, “our” and “we” refer to Northeast National Brokerage, LLC. To learn more about our information practices and your rights, please read our Privacy Notice (CA): California Privacy Notice

NNB-Access & Deletion Rights Request Form

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Section 1. Your Information

Please provide the information below so we can verify your identity and California residency. (Fields marked with an asterisk are mandatory.)

Name*

First Last

Email*

Address*

Street Address Address Line 2 City State ZIP Code

Phone