CCPA Request Form

Begin your CoastHills Federal Credit Union CCPA request regarding your personal information by completing this form.

* indicates a required field

Please select your current state of residence

Please select your current state of residence is a required field

Please enter your date of birth

Date of Birth (MM/DD/YYYY)

When was your last contact or interaction with CoastHills Credit Union?

Please select your request type(s)* I want access to personal information that has been collected or shared I want to request that personal information be deleted

Please select your request type(s)* is a required field

What is your relationship with CoastHills Credit Union?*

What is your relationship with CoastHills Credit Union?* is a required field

If other, please explain

How do you want us to respond to your request?*

How do you want us to respond to your request?* is a required field

First Name*

First Name* is a required field

Last Name*

Last Name* is a required field

Suffix

Street Address (No PO Box)*

Street Address (No PO Box)* is a required field

Mailing Address

Apartment or Suite Number

Email*

Email* is a required field

Please re-enter your email address*

Please re-enter your email address* is a required field
Email fields must match.

Phone*

Phone* is a required field

Country*

Country* is a required field

City*

City* is a required field

State*

State* is a required field

Zip Code*

Zip Code* is a required field

For security purposes, please do not include your account number, social security number, or any other sensitive personal information on this form.

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CCPA Request Form

Begin your CoastHills Federal Credit Union CCPA request regarding your personal information by completing this form.

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