Community Source Federal Credit Union
PRIVACY OF MEMBER AND FORMER MEMBER INFORMATION

To Community Source Federal Credit Union:
I want to opt out of the disclosure of nonpublic personal information
about me to third parties who may use the information to market non-Credit
Union services to me. I understand I can change my opt-out election any
time by contacting the Credit Union.


My Name:_______________________________________________________

My Address:_____________________________________________________

_______________________________________________________________

My Account Number(s):___________________________________________



______________________________________
Signature 			Date

If this opt out applies to a joint account, or joint loan, the opt out will apply to
myself and the joint owners/borrowers identified below:

Joint Name:________________________ Account Number :___________________


Joint Name:________________________ Account Number :___________________


Mail this form to: Member Services, Community Source Federal Credit Union, P. O.
Box 1413, Bartlesville, OK 74005.