KeyPoint Credit Union
Privacy Opt-Out Election Form

This form allows you to opt-out of the disclosure of non-public personal information
about you to third parties who will use the information to market non-Credit Union
service to you, and to opt out of exchange of the exchange of information between
the Credit Union and the CUSO except for transaction and experience information. Please understand, it will take about 4 weeks to implement this request. You can change your
opt-out election at any time by contacting the Credit Union.

My Privacy Instructions
To: KeyPoint Credit Union and its affiliate, KeyPoint Financial Services, Inc.
	Do not disclose non-public personal information about me to joint marketing partners.
	Do not exchange non-public personal information about me, other than transaction and experience information, between KeyPoint Credit Union and KeyPoint Financial Services, Inc.
	Do not use for marketing purposes any non-public personal information about me exchanged between KeyPoint Credit Union and KeyPoint Financial Services, Inc.
	I give you permission to give non-public personal information about me to third parties to whom disclosure is necessary to conduct the Credit Union or CUSO’s business or to process my transactions.

Personal Information

Account Number:

First Name:

Last Name:

Home Address:

City:

State:

ZIP code:

Last 4 digits of Social Security Number:

Phone:
- -

Email:

I am submitting these privacy instructions on behalf of:
	only myself (the person whose social security number is given above).
	myself (the person whose social security number is given above) and any joint owners or joint obligors on my credit union accounts or loans.

If you prefer to mail the form, follow these instructions:
(You may also submit the form in person at any KeyPoint Credit Union branch or CUSO office)

Click on this link to access the Privacy Opt-Out Election form in the Adobe PDF file format.
Privacy Opt-Out Form (PDF doc)
Print the Privacy Opt-Out Form (PDF document).
Complete the requested information.
Mail completed form to:

KeyPoint Credit Union
2805 Bowers Avenue
Santa Clara, CA 95051
ATTN: Privacy Opt-Out

KeyPoint Credit Union Privacy Opt-Out Election Form

KeyPoint Credit Union
Privacy Opt-Out Election Form