CCPA Request Form Name Loan Number Property Address City and State Zip Code Mailing Address (if different) City and State Zip Code Phone Number If you DO NOT have an account with Rushmore, please provide additional information in the field below in order to facilitate our review. Such information may include any supporting documentation to reflect how you may be affiliated with a Rushmore account. Items such as your date of birth, Social Security Number, or other such non-public information is not required. I/We hereby authorize RUSHMORE to review its system of record and determine what information, if any, Rushmore may have pertaining to my personal information request. I attest that request is made in good faith and I am the person requesting this information.