Privacy Electronic Form

Mail-in Form
Leave Blank OR (if you have a joint account, your choice will apply to everyone on your account unless you mark below) ______   Apply my choices only to me	Mark if you want to limit:           ____ Do not allow your affiliates to use my personal information to market me
	Name		Mail to: Oneida Savings PO Box 240 Oneida NY 13421-0240
	Address
	City, State, Zip
	Account Number (Last 4 digits of one account)