Dec 102020 CCPA OPT OUT REQUEST FORM Consumer Request Submission Form for California Residents Thank you for contacting Mercedes-Benz U.S. International (MBUSI). California residents may use the this form to submit a consumer rights request under the California Consumer Privacy Act of 2018. Please fill-in the fields below (all are required) and click the "SUBMIT" button to make your Privacy inquiry. For more information about our privacy practices, please refer to our MBUSI Privacy Policy page. First Name(*) Invalid Input Last Name(*) Invalid Input E-mail Address(*) Invalid Input State of Residence(*) Invalid Input Privacy consent(*) I consent to MBUSI collecting and using the Personally Identifiable Information (PII) I have provided herein for the sole purpose of responding to my consumer rights request. (Your consent is required in order to submit this form.) Your consent is required. BY SUBMITTING THIS FORM, I CONFIRM THAT I AM A RESIDENT OF CALIFORNIA AND THAT THE INFORMATION I HAVE PROVIDED IS COMPLETE AND ACCURATE. Antispam challenge(*) Refresh Invalid Input SUBMIT
