Your Privacy Choice

Do not share member information about me to third parties who will use the information to market non-credit union services to me. I understand it will take up to four weeks to implement my request. I can change my privacy choice at any time by contacting the Credit Union.

Provident Member Number
Full Name
Street Address (No Post Office Box)
City
State/Zip
Daytime Phone Number	() -, ext.
Evening Phone Number	() -, ext.

Request to Opt Out Signature:

(Must be signed in ink to comply with request)

Your preference will apply to all accounts linked to your Member Number. For joint accounts, any account holder can make their selection on behalf of the other joint account holders.

Complete this Page, Print, Sign, then Return to:

Records Department
Provident Credit Union
303 Twin Dolphin Drive
Redwood Shores, CA 94065