|FORMS: 5.4 OPT OUT LETTER|
|RIGHT click here for the Word 97 version of this document|
The letter below is intended to be sent to your financial institution in order to protect the privacy of your financial records.
TO [COMPANY NAME]:
State and Zip Code:
ATTN: "OPT OUT" Department
MY FULL NAME IS:
FULL STREET ADDRESS
STATE AND ZIP CODE
RE: These accounts. I am listing my name, the name of my
account, and my account numbers here:
1. I am asserting my rights under the Financial Services
Modernization Act and the Fair Credit Reporting Act to "opt
out" of the following two uses of my personal information:
a. You do not have permission to disclose personally
identifiable information with your non-affiliated
third-party companies or individuals.
b. You do not have permission to disclose my
creditworthiness to any affiliate.
2. I am further instructing you:
a. Do not disclose any of my transaction and
experience information to any affiliate of yours.
b. Do not disclose any information about me in
connection with marketing agreements between you and
any other company.
3. Please respond to me in writing stating that you
will comply with these instructions. If I have not
received a letter within thirty days specifically
denying my instructions, I will assume your records
have been noted to comply with this letter.
I am mailing this in a sealed envelope, and I am NOT including my social security number. I believe my name and account number identify me sufficiently.
SIGNATURE AND DATE:
Copyright Family Guardian Fellowship
|Last revision: April 02, 2009 04:08 PM|
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