Privacy Information Request

Instructions
Please fill in all fields below, print out the form and then send by postal mail.

Anchor of Hope Charities

10308 Stormhaven Way
Indianapolis, IN  46256



First Name:

Last Name:

Address:

City & State:

Zip Code:

E-mail:

Your Request:

Please Delete my personal information.

Please Discontinue further use of my personal information.

Please Provide me with all the personal information you have collected.

By signing this form, I attest to the fact that I am the individual named above.

 

____________________
Signature

 

_________________
Date