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C-1—Model Form for Initial Opt-Out Notice (Single-Affiliate Notice)

[Your Choice to Limit Marketing]/[Marketing Opt-Out]
  • [Name of affiliate] is providing this notice.
  • [Optional: Federal law gives you the right to limit some but not all marketing from our affiliates. Federal law also requires us to give you this notice to tell you about your choice to limit marketing from our affiliates.]
  • You may limit our affiliates in the [ABC] group of companies, such as our [credit card, insurance brokerage, and securities brokerage] affiliates, from marketing their products or services to you based on your personal information that we collect and share with them. This information includes your [income], your [account history with us], and your [credit score].
  • Your choice to limit marketing offers from our affiliates will apply [until you tell us to change your choice]/[for x years from when you tell us your choice]/[for at least 5 years from when you tell us your choice]. [Include if the opt-out period expires.] Once that period expires, you will receive a renewal notice that will allow you to continue to limit marketing offers from our affiliates for [another x years]/[at least another 5 years].
  • [Include, if applicable, in a subsequent notice, including an annual notice, for consumers who may have previously opted out.] If you have already made a choice to limit marketing offers from our affiliates, you do not need to act again until you receive the renewal notice.
To limit marketing offers, contact us [include all that apply]:
  • By telephone: 1-877-###-####
  • On the web: www. 
    .com
  • By mail: Check the box and complete the form below, and send the form to:[Company name][Company address]

 Do not allow your affiliates to use my personal information to market to me.

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