Gramm Leach Bliley Act
Sample Notice C - Privacy Notice
In connection with your transaction, [name of dealership] may obtain information about you as
described in this notice, which we handle as stated in this notice.
- We collect nonpublic personal information about you from the following sources;
- Information we receive from you on applications or other forms
- Information about your transactions with us, our affiliates or others
- Information we receive from a consumer reporting agency - We may disclose all of the information that we collect about you as described above, while you are a consumer, customer, or former customer, to our affiliates and to non-affiliated third parties.
- We may disclose nonpublic personal information about you, while you are a consumer,
customer, or former customer, to the following types of third parties
- Financial service providers, such as [provide illustrative examples]
- Non-financial companies, such as [provide illustrative examples, such as “market research firms”, “automobile manufacturers”]
- Others, such as [provide illustrative examples] - We may also disclose nonpublic personal information about you to nonaffiliated third parties as permitted by law.
- If you prefer that we not disclose nonpublic personal information about you to nonaffiliated third parties, you may opt out of those disclosures; that is, you may direct us not to make those disclosures (other than disclosures permitted by laws). If you wish to opt out of disclosures to nonaffiliated third parties, you may [describe a reasonable means of opting out (choose one of the acceptable options described in the accompanying bulletin)].
- We may also disclose, while you are a consumer, customer, or former customer, any information we collect about you to companies that perform marketing services on our behalf or to other financial institutions with whom we have joint marketing agreements. This disclosure is permitted by law; there is no opt-out opportunity available.
- We may disclose nonpublic personal information about you, while you are a consumer, customer, or former customer, to the following types of affiliates: [Describe affiliates by categories. Provide illustrative examples.]
- We restrict access to nonpublic information about you to [provide an appropriate description, such as “those employees who need to know that information to provide products or services to you”]. We maintain physical, electronic, and procedural safeguards that comply with federal regulations to guard your nonpublic personal information.
CUSTOMER ACKNOWLEDGMENT: I (we) acknowledge that I (we) received a copy of this notice on the date indicated below.
| __________________________ Date |
________________________________________ Customer's Signature |
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| ________________________________________ Customer's Name (printed) |
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| __________________________ Date |
________________________________________ Co-customer's Signature |
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| ________________________________________ Co-customer's Name (printed) |