Date:

To whom it may concern:
I request to have my name removed from your marketing lists. Here is the information you have asked me to include in my request:
 

FIRST, MIDDLE & LAST NAME:
CURRENT MAILING ADDRESS:

PREVIOUS MAILING ADDRESS
(if you have moved in the last six months)

SOCIAL SECURITY NUMBER:___________________
DATE OF BIRTH:____________________

 

Thank you for your prompt handling of my request,
 

____________________________
  Signature of