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California Consumer Privacy Act Request Form

  • By filling out this form, you request that Park National Bank provide you with details of any personal information that Park has collected from or about you or that Park delete such information. If you have a customer relationship with us, we will respond to your request using the contact information we have on file for you. If you are not our customer we will respond to your request using the address you provide below. Note: Proper authentication is required to ensure protection of personal information. You may be required to provide proof of identify before Park will respond to your request.

  • Personal Details:

  • MM slash DD slash YYYY
  • Please enter a number less than or equal to 9999.

  • Contact Info:

    *You must be a person authorized to act on behalf of the consumer or a parent or legal guardian of a minor child to submit a CCPA request. You will be required to provide supporting documentation. Request and supporting document that cannot be verified will not be processed.
  • Upon the receipt of a verifiable request, Park will disclose and deliver the requested information, either electronically or by U.S. mail, no later than 45 days from the receipt of your request, unless additional time is required. Park will notify you if additional time is required to complete your request. The information provided will cover the 12 month period preceding the date of your request. In some instances, we may not be able to honor your request. For example, we will not honor a request if we are unable to verify your identity or are unable to verify that you have the authority to make a request on the behalf of another person. Additionally, we will not honor your request where an exception applies, such as when the personal information that we maintain is not subject to the CCPA’s access or deletion rights. We will advise you if we are not able to honor your request and the reason(s) why. We will not honor request from individuals who are not residents of California.
  • This field is for validation purposes and should be left unchanged.