CCPA Intake Details

Please use this form to submit a Privacy Request for the Access or Deletion of your Personal Information pursuant to the California Consumer Privacy Act (CCPA).

Requestor Details

Are you making this request on behalf of someone else?*

Consumer Name and Relationship

Name*
Describe your relationship with Charlotte Russe*

Customer Contact Information

Address*
Do you declare that you are the person named above or are authorized to submit this form for the descrived person or household. Durthermore, do you certify (or declare) under the penalty of perjury under the laws of the State of California that the foregoing is true and correct.*
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