CONSUMER PRIVACY REQUEST FORM – Blue River Pet Care

California Consumer Privacy Act

Under the California Consumer Privacy Act (CCPA), California residents are entitled to make certain requests regarding the personal information that Blue River PetCare collects, uses, or shares about them. Please review our Privacy Policy for further information on what information we collect and why we collect it.

If you are a California resident or the authorized agent of a California resident and would like to submit a request under CCPA, please complete the below form. Please submit a separate request on behalf of each California consumer. We ask that you provide this information so that we can verify your identity and respond to your request.

I am a(n):
- California Resident / Consumer requesting information about myself or a member of my household.
- Authorized Agent requesting information about a California Resident / Consumer
Authorized Agent Name*
First Last
Authorized Agent Email*
Please upload:
• the consumer’s power of attorney authorizing the authorized agent to act on behalf of the consumer OR the consumer’s written authorization permitting the authorized agent to make the request.
Drop files here or
Consumer’s Name*
First Last
Any other name(s)
First Last
Consumer’s Email*
Consumer’s Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Consumer’s Phone Number*
Pet's Name*
Date of last visit or appointment
Date Format: MM slash DD slash YYYY
I am requesting the following*
- ACCESS to the categories of personal information the Company has collected, the categories of sources from which personal information was collected, the business or commercial purpose for collecting my personal information, and the categories of third parties with whom the Company shares my personal information.
- ACCESS to specific pieces of personal information the Company has collected about me.
- DELETION of the personal information that the Company has collected.
The specific pieces of personal information I am requesting are as follows:
Consent*
By checking this box, under penalty of perjury, I declare the above information is true, correct and that I am the consumer who is the subject of the request or have been authorized by that consumer to act on his/her behalf, as indicated above. I understand that it may be necessary for Company to verify the identity of the consumer and/or authorized agent for this request, and that additional information may be requested for this purpose.