CCPA Form by bhs-ahAdmin For California Residents Only I confirm that I am a resident of the state of California Please complete this form if you are a current resident of California, who wishes to exercise the rights given to you by the California Consumer Privacy Act (CCPA) regarding access to your personal information FOR CALIFORNIA RESIDENTS ONLY First Name Last Name Email ID Country State —Please choose an option— Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Request Type —Please choose an option— Access my personal information Delete my personal information Prohibit the sale of my personal information Enter your request details Upon submitting this form, I agree that the information provided in this form is accurate and complete Submit
