Third Party Sharing
To Opt-out of information sharing, please complete this form and follow the instructions indicated below.
(A summary of the Act can be retrieved at: https://www.congress.gov/bill/106thcongress/senate-bill/900) I elect that you do not share my information, other than that which is allowed by law.
Please print this form and complete/sign below:
Full Legal Name:
Social Security Number:
Questions? Please call (312) 924-3737. Please allow thirty (30) days for your election to become effective.
Please send completed form, via registered or overnight mail, to:
333 North Michigan Avenue
Chicago, IL 60601
This Opt-Out Form is effective March 1, 2019.