Free Privacy Request Form template (text download)

Published Sep 29, 2026 · Last reviewed Sep 29, 2026 · by Agent Exchange

A consumer request form covering access, deletion, correction, opt-out of sale or sharing and limiting sensitive data, with the verification, authorized-agent and deadline language the CCPA regulations and the other state laws expect. Bracketed text marks what you fill in. Download the file or copy it; the generator version fills the brackets for you.

Privacy request form ([Site name])
[Site name] ([https://example.com]) · Submit by: the online form at [your request page URL], email [contact email], or toll-free [toll-free number, if you offer one]

Request type (tick all that apply):
[ ] Access: tell me what personal information you hold about me and how it is used
[ ] Delete my personal information
[ ] Correct inaccurate personal information
[ ] Opt out of the sale or sharing of my personal information
[ ] Limit the use of my sensitive personal information
[ ] Other right under the law of my state or country: ______________________

1. Full name: ______________________
2. Email address associated with your account or data: ______________________
3. Which of our products, accounts or orders this concerns: ______________________
4. Anything that helps us find your data or verify your identity (never send a password): ______________________
5. Are you submitting this as an authorized agent for someone else?   [ ] no   [ ] yes (attach proof of authority)
6. Your state or country of residence: ______________________
7. I confirm that I am the person whose data this request concerns, or their authorized agent, and that the information provided is accurate.   [ ] I agree
8. Signature (typed): ______________________   Date: ______________

What happens next: we confirm receipt within 10 business days, verify your identity using information we already hold, and respond within 45 days (one month under the GDPR); we may extend once where the law allows and will tell you why. Opt-out requests are honored within 15 business days. You will not be discriminated against for exercising your rights. We keep a record of this request for 24 months.

What a Privacy Request Form must contain

At least two request methods for covered businesses: a web form plus an email address or a toll-free number (an online-only business with a direct consumer relationship may use just an email address).
Request types: know or access, delete, correct, opt out of sale or sharing, limit use of sensitive personal information; authorized agents with proof of authority.
Identity verification proportional to the request, using data you already hold, never a password.
Timelines: confirm receipt within 10 business days; respond within 45 calendar days, extendable once by 45 days with an explanation; honor opt-outs within 15 business days; GDPR access within one month, extendable by two.
No discrimination for exercising rights; keep records of requests and responses for 24 months.

Primary sources: California Attorney General: CCPA · Regulation (EU) 2016/679, GDPR, Articles 12 and 15 (EUR-Lex). Informational, not legal advice.

The document is the notice; the desk is the process. The Privacy Request Desk hosts the request form this document points to: ticket numbers, the 45 days deadline clock, a status page for the requester, and an exportable log for you. Base desk free during launch. Create the privacy request desk

Other free templates

Compliance Desk by agentexchange.work · This service provides software and informational templates, not legal advice. Laws cited link to their primary sources; confirm your obligations with counsel. · Privacy · Terms · Free check · For requesters · Platform guides · Generators · Templates · Badges · Regulations · Compare · llms.txt
All properties: network.agentexchange.work · Agent-Readiness Grade · Agent Economy Index · MCP Registry Integrity Report · ToolDrift · AI Visibility