Data Broker Opt-Out Request

Data Broker Opt-Out Request — Form Fields

This legal template includes 7 fields. Individuals formally request removal of their personal data from data broker platforms. Free to customize and use on ZenBuild.

• Full Name (text, required)
• Email Address Used in Records (email, required)
• Phone Number in Records (text, optional)
• Home or Previous Address (text, required)
• Date of Birth (for identity match) (text, required)
• Names of Specific Data Brokers to Contact (long text, optional)
• I request removal of my personal information from all data brokers (checkboxes, required)