| Customer
Preference Notification Form
If you have previously notified
us of your privacy preferences, there is no need to return
the Customer Preference Notification Form. No further notification
of any sort is required unless you wish to modify them. We
will continue to respect the choices you have previously communicated
to us.
If
you wish to exercise either or both information sharing
options described in Protecting Your Privacy, please
print this form, check the box(es) below where indicated,
and complete the required information.
 |
Please
exclude me from information sharing among your
affiliates as described in section 5 of Protecting
Your Privacy.
|
|
Please
exclude me from information sharing with nonaffiliated
third parties as described in section 5 of Protecting
Your Privacy. |
If
you exercise either or both of the options above,
your decision will also apply to others with whom
you jointly hold accounts with us. If you have more
than one account with us, it is not necessary for
you to respond for each of your accounts. You need
only respond once.
Please
remember that you can instruct us about your privacy
preferences at any time by contacting us at the address
below.
| Name
(please print): |
_________________________________
|
Address:
|
_________________________________
|
Apt. #:
|
_________________________________
|
City: |
_________________________________
|
State:
|
_________________________________
|
Zip Code:
|
_________________________________
|
Last 4 digits of your
Social Security Number(s)
(used to access your records): |
_________________________________
|
Detach this form, and mail it back to us at the
following address:
The Bank of New York Mellon Corporation
P.O. Box 535009
Pittsburgh, PA 15253-5009
RET-PRVINS-0707A
|
