California Consumer Privacy Act (CCPA) - Information Request Black Bear Diner does not currently sell personal information. By submitting this request, I certify, under penalty of perjury, that I am a California resident and can provide documentation substantiating state residency if requested. Please complete the information below. You will be contacted within 45 days.Please provide the following information:I am a California Resident:NoYesBlack Bear Diner will not fulfill your request under the California Consumer Privacy Act because you are not a California Resident. Please note you must be a California resident to request information based on the California Consumer Privacy Act. Name * Required First Last Email Address Used * Required Enter Email Confirm Email Black Bear Diner will only fulfill CCPA requests from California residents. Please check your address and try again.California Mailing Address (Where we will send any requested information) * Required Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone * RequiredPlease indicate your request: * RequiredAccess Request: Please send me a copy of the information Black Bear Diner has collected about me in the last twelve months.Request to Know: • Categories of personal information collected about me in the last twelve months. • Categories of sources from which the personal information about me was collected. • Business purpose for which Black Bear Diner uses the personal information collected about me • Categories of third parties with whom Black Bear Diner shares or has shared the personal information collected about me in the last twelve months.Request for Deletion: Please delete all personal information that Black Bear Diner has collected from me.Request to Opt Out of Sale of Information: I do not want my personal information to be sold. Please cease and refrain from selling my personal information. (Please note that Black Bear Diner does not currently sell personal information and does not intend to do so in the future.)Request to Withdraw From Financial Incentive Program: I wish to withdraw from the Company’s financial incentive or loyalty rewards program (eClub and Passport). Please delete my account. I understand that by withdrawing from the program and having my account deleted, I will not be receiving any of the financial incentives, rewards, benefits or discounts that I may have previously earned or accrued as a member of this program.This request has been submitted through an agent on my behalf: * RequiredNoYesName * Required First Last This agent has been authorized in writing to submit this request on my behalf: * RequiredNoYesCAPTCHACommentsThis field is for validation purposes and should be left unchanged.