Third Party Sharing

The Gramm-Leach-Bliley Act ("Act"), as enacted by Congress, sets forth new standards for financial institutions, financial service providers, insurance companies, etc. regarding the disclosure of non-public, personal information. The Act generally prohibits TransferMate, (the "Company") from sharing non-public personal information about you with a third party unless we provide you with the Company’s Privacy Policy describing the type of information that we collect about you and the persons or types of entities to whom that information may be disclosed. The Act also provides you with the affirmative right to “Opt-out” of such information 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: I elect that you do not share my information, other than that which is allowed by law.
The Company’s Privacy Policy is posted at

Please print this form and complete/sign below:

Full Legal Name:
Social Security Number:
Cell/Phone Number:
Complete Address:

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
Suite 915
Chicago, IL 60601

This Opt-Out Form is effective March 1, 2019.