Data Subject Request Web Form Privacy Requests

Under certain federal and state regulations, consumers may have the right to (1) request and receive a report from Acrisure, LLC and our affiliates, including the Acrisure Agency Partner(s) (collectively, “Acrisure”) of all personal information (as that term is defined under applicable law) collected from the consumer by Acrisure (a “Report Request”); (2) request that Acrisure delete all such personal information from its records (a “Deletion Request”); or (3) provide a customer an opportunity to opt-out of certain disclosures of their personal information.

To submit a Report Request, Deletion Request, or exercise any right you may have to opt-out of Acrisure’s disclosure of your personal information, you may either complete our online forms below or submit a written request to: Acrisure, LLC, 100 Ottawa Avenue SW, Grand Rapids, MI 49503, ATTN: Acrisure Privacy Office.

*Required

Please select the state that you reside in:*

Select request type:*

Select what personal information you would like to receive:*
Request categories of personal information collectedRequest categories of personal information soldRequest categories of personal information disclosed for business purposesRequest categories of sources of personal information collectionRequest purpose for collecting of selling personal informationRequest 3rd parties with whom we share personal information

First Name*

Last Name*

Email*

Phone

Street Address*

City*

State*

Zip Code*

Client ID Number (located on the cover letter you received with your notice, please be sure to include the prefix. Ex. MM-123456)*

First Name*

Last Name*

Email*

Phone

Street Address*

City*

State*

Zip Code*

Client ID Number (located on the cover letter you received with your notice, please be sure to include the prefix. Ex. MM-123456)*

First Name*

Last Name*

Email*

Phone

Street Address*

City*

State*

Zip Code*

Client ID Number (located on the cover letter you received with your notice, please be sure to include the prefix. Ex. MM-123456)*

Under the California Financial Code § 4050 et seq., if you are a California resident, you may have a right to opt-out of our disclosure of your personal information to our affiliates. We share your information with our affiliates to ensure that we are informing you of products and services that our affiliates provide that may be of interest and beneficial to you based on what we know about you as our customer. If you would like to opt out of that sharing, please check the box below.

I no longer want Acrisure to share my personal information with its affiliates to the extent I am able to limit this sharing under applicable law.

First Name*

Last Name*

Email*

Phone

Street Address*

City*

State*

Zip Code*

Client ID Number (located on the cover letter you received with your notice, please be sure to include the prefix. Ex. MM-123456)*

Under the federal Gramm-Leach-Bliley Act, you may have the right to opt-out of our disclosure of your personal information with unaffiliated third parties. If you would like to opt out of that sharing, please check the box below.
I no longer want Acrisure to share my personal information with unaffiliated third parties to the extent I am able to limit this sharing under applicable law.