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| TO: [COMPANY NAME] |
| STREET : |
| ADDRESS: |
| CITY: |
| STATE AND ZIP CODE: |
ATTN: "OPT OUT" Department
| FROM: [FULL NAME] |
| FULL STREET ADDRESS: |
| CITY: |
| STATE AND ZIP CODE: |
RE: MY ACCOUNT(S) WITH YOU
| ACCOUNT NAME/TYPE |
ACCOUNT NUMBER |
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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. Please do not share personally identifiable
information with nonaffiliated third-party companies or
individuals.
b. Please do not disclose my creditworthiness to any affiliate.
2. Further, I request the following, even though
it may not be required by law:
a. Please do not disclose my transaction and
experience information to any affiliate of yours.
b. 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.
Source: Privacy Clearinghouse
and Junkbusters
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