Untitled Document

Allstate Floral: CCPA/CPRA Contact Form
1.

State your full name (first and last): 
2.

Who are you making this request on behalf of:

  •   Self. Please skip to Question #3
  •   Agent for a requestor. Please go to Question #4.
3

If you are making this request on behalf of yourself, are you a California resident?

  •    Yes. Please go to Question #6.         No. Please go to Question #8.
4.

If you are an agent for the requestor, is the requestor a California resident?

  •    Yes. Please go to Question #5          No. Please go to Question #8.
5.

If you are an agent for the requestor, do you have signed written authorization permitting you to act on behalf of the requestor?

  •    Yes. Please use this link to upload a copy of the written authorization. Please go to Question #6 after uploading the authorization.
  •    No. Please go to Question #6.
6.

Please check the box that best describes the relationship between Allstate Floral and you OR Allstate Floral and the requestor. You may check more than one box, if applicable.

  •  a.  Customer - current or former
    • Please state your customer number. 
    • If you are a sole proprietor, please state the company name. 
  •  b.  Current employee or temporary employee
    • What is your OR the requestor’s job title at Allstate Floral? 
    • Please state the manager’s full name. 
    • Please state your OR the requestor’s employee ID number. 
  •  c.  Former employee
    • What was the last date of employment at Allstate Floral? 
    • Please state the job title. 
    • Please state the manager's full name. 
    • Please state your OR the requestor's employee ID number when employed at Allstate Floral. 
  •  d.  Job applicant
    • Please state the date an application for employment was submitted to Allstate Floral (month and year).
    • Please state the position applied for. 
  •  e.  Independent contractor
    • Please state the ID number. 

  •  f.  Vendor/service provider
    • Please state the name of the vendor company. 
    • Please state the vendor ID number. 
  •  g.  Website visitor
    • Please provide the date (month, day, and year) of the most recent visit to Allstate Floral's website. 
    • Please provide one of the following pieces of information:
      • IP address: 
      • Device ID: 
      • Browser ID: 
7. What request is being made to Allstate Floral?
  •   a.  Right to Know
  •   c.  Right to Correct
  •   b.  Right to Delete
8. Please provide the email address or mailing address where you want us to contact you regarding this request.
  •   Email address: 
  •   Mailing address: 
  Enter Text Below:
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