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California Privacy Rights Request Form
This is the Privacy Rights Request Form of Krüger North America, Inc. ("KNA," "we," "us," or "our"), operator of the MaxiNutrition USA online shop at hello@maxinutrition.us for California residents. If you are a California resident, under the California Consumer Privacy Act of 2018, as amended by the California Privacy Rights Act of 2020 (together, the "CCPA"), you have the right to request to know about the personal information we have collected about you over the last 12 months, the right to request that we correct inaccurate personal information, the right to request that we delete the personal information we collected from you, and the right to opt out of the sale or sharing of your personal information.
You may exercise your right to request to know twice in a 12-month period, free of charge. Please note that the CCPA prohibits us from disclosing your Social Security number, driver's license number or other government-issued identification number, financial account number, any health insurance or medical identification number, and any account password or security questions and answers in response to a request to know.
Please see our [Privacy Policy] for a description of the personal information we collect and how we use, disclose, sell, and share personal information.
To submit your request to KNA, please complete the form below and send it to hello@maxinutrition.us or by mail to Krüger North America, Inc., Attn: Privacy, 1010 Lake St, Unit 106, Oak Park, IL 60301. You may also call us at +1 708 851-3670. If you are submitting this request on behalf of someone else, please fill out the form with the information of the person for whom you are making the request and complete Section 4.
1. Who is submitting this request?
☐ I am submitting this request for myself.
☐ I am an authorized agent submitting this request on behalf of a California resident (complete Section 4).
☐ I am a parent or guardian submitting this request on behalf of a minor.
2. Consumer information
Please provide the information of the person whose personal information is the subject of this request. We will use this information only to verify your identity and to respond to your request.
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Full name |
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E-mail address (the one used on our website, if any) |
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Telephone number |
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Street address |
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City, State, ZIP |
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☐ I confirm that I am (or the consumer is) a California resident.
Relationship with MaxiNutrition USA: ☐ Customer ☐ Newsletter subscriber ☐ Website visitor ☐ Other
3. Type of request (check all that apply)
☐ Right to know – categories. Tell me the categories of personal information you have collected about me, the categories of sources, the business purposes, and the categories of third parties with whom it was disclosed, sold, or shared.
☐ Right to know – specific pieces. Provide me with the specific pieces of personal information you have collected about me.
☐ Right to correct. Correct the following inaccurate personal information: ____________________________________________
☐ Right to delete. Delete the personal information you have collected from me. (Note: we may retain certain information where permitted by law, e.g. to complete a transaction, comply with legal obligations, or detect fraud. If so, we will tell you why.)
☐ Right to opt out of sale or sharing. Do not sell or share my personal information or use it for cross-context behavioral advertising.
Preferred delivery method for our response: ☐ E-mail ☐ Postal mail
4. Authorized agent (if applicable)
If you are submitting this request on behalf of another person, we require proof that you are authorized to act on their behalf: either a signed written permission from the consumer, a power of attorney, or proof of legal guardianship. We may also contact the consumer directly to confirm the request and to verify their identity.
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Agent full name |
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Agent e-mail address |
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Agent telephone number |
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Type of authorization provided: ☐ Signed permission ☐ Power of attorney ☐ Legal guardianship
5. Declaration and signature
I declare under penalty of perjury that the information provided in this form is true and correct, that I am the consumer named above or an authorized agent of that consumer, and that I am (or the consumer is) a resident of California.
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Signature |
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Printed name |
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Date |
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What happens next
We will confirm receipt of your request within 10 business days and respond within 45 calendar days. If we need more time (up to an additional 45 days), we will let you know the reason. To protect your information, we will verify your identity by matching the information you provide with the information we have on file; we may ask you for additional information if needed. We will not discriminate against you for exercising your privacy rights.
Questions? Contact us hello@maxinutrition.us or at the address above.