Privacy Rights Clearinghouse
TO: [COMPANY NAME]
State and Zip Code:
ATTN: "OPT OUT" Department
FROM: [FULL NAME]
FULL STREET ADDRESS
STATE AND ZIP CODE
RE: MY ACCOUNT(S) WITH YOU
[List Name/Type of Account & Acct. Nos.]
- 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:
- Please do not disclose personally identifiable information with your non-affiliated third-party companies or individuals.
- Please do not disclose my creditworthiness to any affiliate.
- Further, I request the following, even though it may not be required by law:
- Please, do not disclose my transaction and experience information to any affiliate of yours.
- Please, do not disclose any information about me in connection with marketing agreements between you and any other company.
- Thank you for respecting my privacy and honoring my choices regarding my customer information. I would appreciate confirmation from you regarding my requests.
SIGNATURE & DATE: