DNC REQUESTS RECORD

Approx. Date Registered on Federal "Do Not Call" list - 

Phone Numbers Registered - 


Approx. Date Registered on State "Do Not Call" list - 

State - 

Phone Numbers Registered - 


===============================================================
ENTRY

Date of Communication -

Caller/Business name -

Number Given by Business -

further data, if available: -

( ) Written request on source document on which telephone number
supplied to business entity

( ) Oral request when correct number supplied to business entity

( ) Oral request during call made with ANI data to business entity
(e.g., "800" call)
 -
Identity given by person receiving request -

Department, office or business function -

date -               time (oral request) -    (local time)


( ) Oral GLBA request, acknowledged as adequate by representative

     Oral GLBA request included:
     ( ) agreement not to share externally
     ( ) agreement not to share with subsidiaries
     ( ) agreement not to mail separate advertisements
     ( ) "do not call" request made
     ( ) "do not call" request made and acknowledged by
          representative

( ) GLBA letter sent with "do not call" request

( ) GLBA letter sent without "do not call" request (still may be
relevant to calls from outside telemarketers)

comments -

Diversion Statement or Refusal by Representative -


Caller ID Indication (if applicable) -

Product or Service Offered -

===============================================================


NOTES

(Save as a text or wordprocessor document and duplicate the
"ENTRY" form within the document.)

Please see http://www.scn.org/~bk269/dnc_frm which describes
potential legal inadequacies of this form.

This is written as a combined list for "do not call" requests, GLBA
requests, and incoming telemarketing calls, and can be sorted as
desired.  This should be maintained as a proper "regular business
record" to facilitate government or private enforcement.  Copy the
text in any way you find convenient and make frequent (or
automatic) backups.

This is your form.  Delete particular lines in any given
"ENTRY" which are inapplicable.

"GLBA" is the Graham-Leach-Bliley Act (US).  Privacy laws are
governed by the GLBA, FRCA, HIPAA, the Federal Telemarketing Rule,
and various state laws.  A GLBA request is not the same as a "do
not call" request, and it is not yet clear whether the two can be
combined.  Most countries have similar privacy laws (although
most do not require citizens to "opt out").