Fair Credit Reporting Act Opt-Out Request Form

Print this form, complete all information and mail to the address located on the bottom of the form.

Please exclude me from non-experience information sharing within the Bank of America family of companies as described above.

Please print:

Date	__________________________________________________
Name	__________________________________________________
Address/Apt. Number	__________________________________________________
City	__________________________________________________
State	__________________________________________________
Zip Code	__________________________________________________
Social Security Number (Required to process your request)	__________________________________________________
Please provide a telephone number that we may use to contact you if we have questions:	( __________ ) _____________________________________

Account Type(s) (e.g. mortgage, checking, etc.)	Account Number(s)
__________________________________	__________________________________
__________________________________	__________________________________
__________________________________	__________________________________
__________________________________	__________________________________
__________________________________	__________________________________
__________________________________	__________________________________
__________________________________	__________________________________
__________________________________	__________________________________
__________________________________	__________________________________
__________________________________	__________________________________
__________________________________	__________________________________

Please note, earlier elections remain in full force and effect.

Please mail the completed form to:

LaSalle Bank
Attn: Retail Account Maintenance C01-104
5501 South Kedzie
Chicago, IL 60629

Privacy & Security | Terms of Use © 2008 Bank of America Corporation. All rights reserved. Bank of America, N.A., LaSalle Bank N.A., and LaSalle Bank Midwest N.A. Members FDIC. Equal Housing Lenders. Equal Opportunity Lenders. PLEASE NOTE: LaSalle products may not be able to be serviced at Bank of America banking centers or through BankofAmerica.com until late 2008.