Step 1 of 4
(Residents of CA, MN, OR)
Verify your request type and identity.
What type of request?*
Know/Confirm Information Processing CategoriesAccess/Obtain Specific Information ProcessedDelete InformationCorrect InformationObtain a List of 3rd Parties To Which We Have Disclosed Personal Data (Customer/Consumer Only)Opt Out of ADMT (Profiling) (Customer/Consumer Only)Do Not Sell or Share My Personal Information
What type of consumer?*
Customer/ConsumerCurrent/Former Employee (CA Only)Current/Former Job Applicant (CA Only)
Are you acting on behalf of yourself or another person?*(1)
MyselfOther (I am acting as an Authorized Agent)
(1) If you are an authorized agent, please fill out the next steps with the consumer’s information.
Step 2 of 4
To protect the nonpublic personal information CrossCountry Mortgage retains, we need additional verification information to complete your request.
We just need a little more info to fulfill your request
First Name*
Middle Name
Last Name*
Consumer State of Residence*
StateCAMNOR
Date of Birth
MM/DD/YYYY
Authorized Agent First Name
Authorized Agent Last Name
Step 3 of 4
Street Address 1*
Street Address 2
City*
State*
Zip Code*
Consumer’s Phone*
Consumer’s Email*
Confirm Consumer’s Email*
Authorized Agent’s Email*
Confirm Authorized Agent’s Email*
Authorized Agent’s Phone*
Step 4 of 4
Request Details
Authorized Agents:
Please use the area below to upload your authorization to act on the consumer’s behalf as part of your request submission
Requests to Correct:
Please provide details about the information you wish to be corrected in the Request Details area above and upload any documentation related to the contested information in the area below as part of your request submission.
SELECT FILE…
File larger than 4mb are not supported.
I declare under penalty of perjury that the foregoing is true and correct and that I am the consumer (or the consumer's Authorized Agent) whose personal information is the subject of this request.
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