California Consumer Privacy Act Request Form

California residents can use this form to submit requests under the California Consumer Privacy Act (“CCPA”) regarding personal information collected by Old Second National Bank (“Old Second”). Federal and/or state financial privacy laws are generally applicable to Old Second, including the Gramm-Leach-Bliley Act (“GLBA”). Personal information governed by GLBA is exempt from the CCPA. As such, this form is likely only applicable to CCPA requests from our individual business customers that reside in California. Our U.S. Privacy Policy regarding personal information covered by GLBA can be found here. Old Second reserves the right to refuse requests, in part or in whole, to the extent permitted by law, if we are unable to verify your identity, or if we cannot verify your authority to act on behalf of another person.

We may ask for additional information or documents to verify your identity. The information provided through this form is used to help us respond to your request.

Consumer information1 and Residence2


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By clicking the “submit” button below, I hereby certify: (a) that the information entered into this form is complete and accurate, (b) I understand that it may be necessary for Old Second to verify the identity of the consumer and/or authorized agent for this request, and (c) additional information may be requested for this purpose if we cannot verify your identity.