CCPA Form by bhs-ahAdmin February 1, 2021 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—AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode Islandouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Request Type —Please choose an option—Access my personal informationDelete my personal informationProhibit 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 Please note: the information you provide in this form will only be used for the purpose of verifying your identity. As we inspect, we may request more information. Feel free to contact us with any queries about the progress of your response.
