Privacy at ChoicePoint: Opt-out Form for Certain Public Facing Products


Please enter the following information on this form, for yourself first, then click the "Add" button. Repeat this for each family member living in the same household, pressing "Add" after each. When you are finished, click "Finished" to proceed to the next step. A summary page will be presented which you can print and save for your records. Items marked with * are required.
Last Name *	Suffix
First Name *
Middle Name

E-mail Address	Phone	(ex:770.123.4567)

Address *

Reason for your request *

City *

State *

Zip *