CCPA Compliance - AIS Insurance

First Name*

Last Name*

Date of birth*

Mailing Address* (CA Residential Address)

APT#

City*

State*

Zip code*

Email Address*

Primary Phone Number*

Policy Number

Are you currently, or have you ever been, an AIS Insurance employee, or applied for employment with AIS Insurance?

Yes

No

Access my Information

Delete my Information

Opt Out of Sale and Sharing or Use for Targeting Advertising

Limit the Use of my Sensitive Personal Information

Correct my Information

What else would you like to share with us about your request?

What type of insurance do you have that is managed by AIS?

Auto

Home

Condo

Renters

Business

Umbrella

RV

Other

How would you like to receive your information?

Email

US Mail

If you are making this request on behalf of another consumer or a minor child - please explain: