Consumer Privacy Request Form
Are you a resident of CA? (This is ONLY for California Residents)
*
-- Select an option --
Yes
No
I am a
*
-- Select an option --
Customer
Buyer
Client
Consumer
Account Holder
Borrower
Other
Type of Service used within the last year? (If there are multiple services, please complete a form for each service.)
*
-- Select an option --
none
Title/Escrow
Default/Foreclosure/Refinance
Other
If Other Specify Service (Do Not Leave Blank if Not Applicable Type N/A)
*
Escrow/Title/Other File #
*
Request Submitted by
-- Select an option --
none
self
household
Third Party
Type of Request
*
-- Select an option --
Delete My Information (Requires Declaration Page, Proof of Identity, and proof CA Residency)
Disclose Specific Pieces of Information (Requires signed declaration, proof of identity, and CA residency))
Disclose Categories of Personal Information
If you made a previous request, enter the number here
First Name
*
Middle Name
Last Name
*
address 1
*
address 2
city
*
State Of Residence
*
zip code
*
phone number
*
email
*
Preferred Response Method
*
-- Select an option --
Email
Certified Mail
Comment (max 550 characters)
Property Address Related to Transaction (Address, City, ST Zip-Code)
Location of Branch (where transaction took place)
Name of Employee (person that completed your transaction)
By submitting this request, I am confirming the following:
(1) Accuracy: the information I have provided is true and accurate; (2) Privacy: that I understand the information will be handled by Orange Coast Title Company in accordance with its Privacy Policy; (3) Contact: that Orange Coast Title Company has the right to contact me to verify my identity and to process this request.
I acknowledge that this request will not be processed until the Consumer Declaration form with appropriate documentation is submitted to our Data Privacy department via email at
[email protected]
or mailed to Orange Coast Title, Attn: Data Privacy, 1551 Tustin Ave, Ste. 300, Santa Ana, CA 92705.
Reset
Submit
Please agree to our terms and conditions to submit this form
Authorization Form
Consumer Declaration
