CCPA Individual Rights Request Form

    You have the right to know what personal information we collect, use, disclose and sell. If you wish to submit a verifiable consumer request for the personal information we collect, use, disclose or sell, or wish to exercise your rights under California law, please complete the following information as accurately as possible. Any information provided here or in the context of completing your request will only be used to satisfy your request:

  • I want to:

    OK I want to: is required
  • OK First Name is required
  • OK Last Name is required

  • Current Customer

    OK Current Customer is required
  • Optional OK Business Name is required
  • OK Address is required
  • OK City is required
  • OK State is required
  • OK Zip Code is required
  • OK Email Address is required
    OK is required

  • Phone Number

    - -
    OK Phone Number is required
    OK is required

  • Preferred Method of Contact

    OK Preferred Method of Contact is required
  • OK Message: is required

    • I consent to be contacted by First Northern Bank.  By clicking “Submit,” you are authorizing First Northern Bank to contact you using the telephone, cell phone number or email address you have provided.  Your authorization means that we can call you even if you have previously registered a federal or state “do not call” preference.

  • OK is required
  • INDIVIDUAL RIGHTS REQUEST FORM UNDER CALIFORNIA CONSUMER PRIVACY ACT
CCPA Request Form

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