California Consumer Privacy Act Request Form
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
*Indicates required field.
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.