CCPA Request Form


Begin your CCPA request regarding your personal information by completing this form

* indicates a required field
  • Please select your current state of residence is a required field
Date of Birth (MM/DD/YYYY)
      • Please select your request type(s)* is a required field
      • What is your relationship with CoastHills Credit Union?* is a required field
        • How do you want us to respond to your request?* is a required field
        • First Name* is a required field
        • Last Name* is a required field
          • Street Address (No PO Box)* is a required field
              • Email* is a required field
              • Please re-enter your email address* is a required field
              • Email fields must match.
              • Phone* is a required field
              • Country* is a required field
              • City* is a required field
              • State* is a required field
              • 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.
              • reCAPTCHA is a required field

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              No matter your inquiry, give us a call at (805) 733-7600, or use one of our other convenient contact methods.